| Name: | Spectracare Health Systems, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 10 Oct 1968 (56 years ago) (Companies founded in October 1968) |
| Entity Number: | 000-070-209 |
| Register Number: | 000070209 |
| Historical Names: |
Wiregrass Mental Health Board, Inc.
|
| ZIP code: | 36303 (Companies in Houston, 36303) |
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | DOTHAN, AL |
| Registered Office Street Address: | 3542 MONTGOMERY HWYDOTHAN, AL 36303 |
| Registered Office Mailing Address: | P.O. BOX 1245DOTHAN, AL 36302 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1568638534 | 2008-04-30 | 2008-04-30 | PO BOX 1245, 2694 SOUTH PARK AVE., DOTHAN, AL, 363021245, US | 134 PREVATT RD, DOTHAN, AL, 363015427, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-712-2720 |
| Fax | 3347122727 |
| Phone | +1 334-794-0731 |
Authorized person
| Name | MRS. MELISSA KIRKLAND |
| Role | EXECUTIVE DIRECTOR |
| Phone | 3347122720 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | 000008817 |
| State | AL |
| Issuer | MEDICAID |
| Number | 590000010 |
| State | AL |
| Issuer | MEDICAID |
| Number | 331600587 |
| State | AL |
| Issuer | MEDICAID |
| Number | 059726100 |
| State | FL |
| Issuer | MEDICARESECONDARY |
| Number | 20427 |
| State | AL |
| Issuer | MEDICAID |
| Number | 331000069 |
| State | AL |
| Issuer | MEDICAID |
| Number | 330034010 |
| State | AL |
| Issuer | MEDICAID |
| Number | 331000067 |
| State | AL |
| Issuer | MEDICAID |
| Number | 331000467 |
| State | AL |
| Issuer | COMMERCIAL INS. |
| Number | 51003550 |
| State | AL |
| Issuer | MEDICAID |
| Number | 33000067 |
| State | AL |
| Issuer | MEDICAID |
| Number | 33034010 |
| State | AL |
| Issuer | MEDICAID |
| Number | 591500003 |
| State | AL |
| Issuer | MEDICARE SECONDARY |
| Number | 14609 |
| State | AL |
| Issuer | MEDICAID |
| Number | 330000010 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51043902 |
| State | AL |
| Issuer | MEDICAID |
| Number | 591600003 |
| State | AL |
| Issuer | MEDICARE SECONDARY |
| Number | 14635 |
| State | AL |
| Issuer | MEDICAID |
| Number | 331600592 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| KIRKLAND, MELISSA | Agent | 3542 MONTGOMERY HWYDOTHAN, AL 36303 |
| Name | Role |
|---|---|
| ELLIOTT, PATRICIA ANN | Incorporator |
| TYSINGER, D S JR MD | Incorporator |
| CONNELL, B W | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2008-11-18 | Name Change | Wiregrass Mental Health Board, Inc. | Spectracare Health Systems, Inc. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
