Basic Information
| Provider Information | |||||||||
| NPI: | 1962540922 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BALDWIN COUNTY MENTAL HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 372 S GREENO RD | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519282871 | ||||||||
| FaxNumber: | 2519280126 | ||||||||
| Practice Location | |||||||||
| Address1: | 372 S GREENO RD | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519282871 | ||||||||
| FaxNumber: | 2519280126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 03/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | ARBOUR | ||||||||
| AuthorizedOfficialFirstName: | SIDNEY | ||||||||
| AuthorizedOfficialMiddleName: | VINCENT | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOC DIR OF TECH SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2519904203 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | AL | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 251B00000X | AL | N | Agencies | Case Management | 251S00000X | AL | N | Agencies | Community/Behavioral Health | 261QM0801X | AL | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 051008122 | 01 | AL | BCBS ALABAMA | OTHER | 330000003 | 05 | AL | MEDICAID |