Healthcare Provider Details

I. General information

NPI: 1154385110
Provider Name (Legal Business Name): BHC - TRUSSVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 VALLEY RD SUITE 200
BIRMINGHAM AL
35235-8668
US

IV. Provider business mailing address

200 BEACON PKWY W SUITE 330
BIRMINGHAM AL
35209-3153
US

V. Phone/Fax

Practice location:
  • Phone: 205-655-7600
  • Fax: 205-655-7446
Mailing address:
  • Phone: 205-715-5910
  • Fax: 205-715-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN M. BLACKBURN
Title or Position: INTERIM PRESIDENT & CEO
Credential:
Phone: 205-715-5901