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

General Provider Information

NPI Number	:	1346642634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION & MENTAL HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2101 MAGNOLIA AVE S
Second Line	:	SUITE 518
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2827
Country	:	US
Telephone Number	:	205-251-7753
Fax Number	:

Provider Business Practice Location Address
First Line	:	11215 HERMITAGE RD STE 204
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-3864
Country	:	US
Telephone Number	:	501-725-8000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARK EDWARDS
Credential	:
Telephone Number	:	205-244-8112

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	10/29/2019

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