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NPI Code Detail

MEDICARE: EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC.

MEDICARE: EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC.
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151022653OTHERALBCBS DR.
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
36231195OTHERALUBH
46232119OTHERALUBH
5510-08117OTHERALBCBS PPO PLANS
66242119OTHERALUBH
76342119OTHERALUBH

General Provider Information

NPI Number : 1285717413
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST CENTRAL MENTAL HEALTH MENTAL RETARDATION, INC.
Provider Business Mailing Address
First Line : 200 CHERRY ST
Second Line :
City : TROY
State : AL
Zip : 36081-2044
Country : US
Telephone Number : 334-566-6022
Fax Number : 334-566-5346
Provider Business Practice Location Address
First Line : 200 CHERRY ST
Second Line :
City : TROY
State : AL
Zip : 36081-2044
Country : US
Telephone Number : 334-566-6022
Fax Number : 334-566-5346
Authorized Official
Title or Position : BUSINESS OFFICE MANAGER
Name : MRS. MALVIA G FRYE
Credential :
Telephone Number : 334-566-6022
Provider Enumeration Date : 10/23/2006
Last Update Date : 06/21/2018

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