MEDICARE: ADDICTION & MENTAL HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1053469593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION & MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 830585
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35283-0585
Country	:	US
Telephone Number	:	205-251-7753
Fax Number	:	205-251-7760

Provider Business Practice Location Address
First Line	:	114 ADRIS PL
Second Line	:
City	:	DOTHAN
State	:	AL
Zip	:	36303-1997
Country	:	US
Telephone Number	:	334-671-1677
Fax Number	:	334-792-0657

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. BERNARD B STEPHENS
Credential	:
Telephone Number	:	205-251-7753

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	10/17/2017

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