Healthcare Provider Details

I. General information

NPI: 1245294339
Provider Name (Legal Business Name): BHC - GARDENDALE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

758 MAIN ST
GARDENDALE AL
35071-2696
US

IV. Provider business mailing address

758 MAIN ST
GARDENDALE AL
35071-2696
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-5521
  • Fax: 205-631-5540
Mailing address:
  • Phone: 205-631-5521
  • Fax: 205-631-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: VALETA D NEAL
Title or Position: PRESIDENT
Credential:
Phone: 205-715-5901