| Name: | The Mental Health Board of Bibb, Pickens, and Tuscaloosa Counties, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 12 Nov 1969 (55 years ago) (Companies founded in November 1969) |
| Entity Number: | 000-070-223 |
| Register Number: | 000070223 |
| Historical Names: |
Mental Health Board of Bibb, Pickens & Tuscaloosa Counties, Inc.
Mental Health/Mental Retardation Board of Bibb, Pickens & Tuscaloosa Counties, Inc. |
| Place of Formation: | Tuscaloosa County |
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LNZ1DHYPMSA5 | 2024-09-13 | 2209 9TH ST, TUSCALOOSA, AL, 35401, 2300, USA | 2209 9TH STREET, TUSCALOOSA, AL, 35401, 2300, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Congressional District | 07 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2023-09-18 |
| Initial Registration Date | 2018-04-27 |
| Entity Start Date | 1969-11-12 |
| Fiscal Year End Close Date | Sep 30 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHERYL DUBOSE |
| Role | CLINICAL DIRECTOR |
| Address | 2209 9TH STREET, TUSCALOOSA, AL, 35401, 2300, USA |
| Title | ALTERNATE POC |
| Name | SANDY CAMPBELL |
| Role | CFO |
| Address | 2209 9TH STREET, TUSCALOOSA, AL, 35401, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | KAREN JONES |
| Role | EXECUTIVE DIRECTOR |
| Address | 2209 9TH STREET, TUSCALOOSA, AL, 35401, 2300, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | KAREN JONES |
| Role | CLINICAL DIRECTOR |
| Address | 2209 9TH STREET, TUSCALOOSA, AL, 35401, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285809194 | 2008-04-23 | 2022-07-21 | PO BOX 2190, TUSCALOOSA, AL, 354032190, US | 1915 6TH ST, TUSCALOOSA, AL, 354011722, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 205-562-3700 |
| Fax | 2055623769 |
Authorized person
| Name | MR. JAMES MOORE |
| Role | EXECUTIVE DIRECTOR |
| Phone | 2055623700 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 528700510 |
| State | AL |
| Issuer | BCBS OF AL |
| Number | 051008111 |
| State | AL |
| Issuer | BCBS OF AL |
| Number | 051511693 |
| State | AL |
| Name | Role |
|---|---|
| BEVERAGE, BILL O | Incorporator |
| OWENS, BEATRICE | Incorporator |
| PEAK, VIRGIL | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2015-06-02 | Name Change | Mental Health/Mental Retardation Board of Bibb, Pickens & Tuscaloosa Counties, Inc. | The Mental Health Board of Bibb, Pickens, and Tuscaloosa Counties, Inc. |
| 1979-07-13 | Name Change | Mental Health Board of Bibb, Pickens & Tuscaloosa Counties, Inc. | Mental Health/Mental Retardation Board of Bibb, Pickens & Tuscaloosa Counties, Inc. |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
