Basic Information
| Provider Information | |||||||||
| NPI: | 1316113541 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALDWIN COUNTY MENTAL HEALTH CENTER, INC. - ALLKIDS PLUS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 S GREENO RD | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519282871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 372 S GREENO RD | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519282871 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | ARBOUR | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | VINCENT | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF TECHNICAL SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2519904203 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BALDWIN COUNTY MENTAL HEALTH CENTER, INC. | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 515-11677 | 01 | AL | BCBS ALLKIDS PLUS | OTHER |