Healthcare Provider Details

I. General information

NPI: 1275687451
Provider Name (Legal Business Name): CHEAHA REGIONAL MENTAL HEALTH MENTAL RETARDATION BOARD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 W 3RD ST
SYLACAUGA AL
35150-1907
US

IV. Provider business mailing address

351 W 3RD ST
SYLACAUGA AL
35150-1907
US

V. Phone/Fax

Practice location:
  • Phone: 256-245-1340
  • Fax: 256-245-1343
Mailing address:
  • Phone: 256-245-1340
  • Fax: 256-245-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateAL

VIII. Authorized Official

Name: MS. SHEILA A. SUMMERS
Title or Position: ELECTRONIC CLAIMS ADMINISTRATOR
Credential:
Phone: 256-245-1340