MEDICARE: ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1346846037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA DEPARTMENT OF MENTAL HEALTH AND MENTAL RETARDATION

Provider Business Mailing Address
First Line	:	PO BOX 301410
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-1410
Country	:	US
Telephone Number	:	334-353-3719
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N UNION ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3719
Country	:	US
Telephone Number	:	334-353-3719
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, SYSTEMS MANAGEMENT
Name	:	RITA WINGARD
Credential	:
Telephone Number	:	334-353-3719

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/09/2020

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