MEDICARE: ALABAMA DEPARTMENT OF MENTAL HEALTH

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	261QR0400X	Rehabilitation Clinic/Center
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1962055699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALABAMA DEPARTMENT OF MENTAL HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 301410
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36130-1410
Country	:	US
Telephone Number	:	334-242-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 N UNION ST # 468
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3719
Country	:	US
Telephone Number	:	334-242-3315
Fax Number	:

Authorized Official
Title or Position	:	CIO
Name	:	SCOTT MARTIN
Credential	:
Telephone Number	:	334-242-3315

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	05/12/2020

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Directions to “ALABAMA DEPARTMENT OF MENTAL HEALTH ” Practice Location

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