Name: | Cahaba Center for Mental Health and Mental Retardation |
Jurisdiction: | Alabama |
Legal type: | Domestic Non-Profit Corporation |
Status: | Exists |
Date of registration: | 03 Oct 1973 (51 years ago) |
Entity Number: | 000-070-237 |
Register Number: | 000070237 |
Historical Names: |
Mental Health and Mental Retardation Board of Dallas, Perry and Wilcox Counties
Cahaba Region Mental Health Center |
Place of Formation: | Dallas County |
Principal Address: | SELMA, AL |
Activities
COMBAT MENTAL ILLNESS
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1134187727 | 2006-05-03 | 2023-01-11 | 417 MEDICAL CENTER PKWY, SELMA, AL, 367017703, US | 1017 MEDICAL CENTER PKWY, SELMA, AL, 367016780, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
Phone | +1 334-875-6068 |
Fax | 3348722084 |
Phone | +1 334-875-2100 |
Fax | 3344186540 |
Authorized person
Name | MRS. CARRIE P BEARDEN |
Role | EXECUTIVE DIRECTOR |
Phone | 3348752100 |
Taxonomy
Taxonomy Code | 251B00000X - Case Management Agency |
Is Primary | No |
Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
Is Primary | No |
Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 590000021 |
State | AL |
Issuer | MEDICAID |
Number | 005437603 |
State | AL |
Issuer | MEDICAID |
Number | 008306000 |
State | AL |
Issuer | MEDICAID |
Number | 330000021 |
State | AL |
Issuer | MEDICAID |
Number | 591700014 |
State | AL |
Issuer | MEDICAID |
Number | 591600014 |
State | AL |
Issuer | MEDICAID |
Number | 330034021 |
State | AL |
Name | Role | Address |
---|---|---|
KNIGHT, JOSEPH S | Incorporator | No data |
GAMBLE, WILLIAM J | Incorporator | 807 SELMA AVESELMA, AL 36701 |
BONNER, REBECCA | Incorporator | No data |
Event Date | Event Type | Old Value | New Value |
---|---|---|---|
1987-09-29 | Name Change | Cahaba Region Mental Health Center | Cahaba Center for Mental Health and Mental Retardation |
1975-05-02 | Name Change | Mental Health and Mental Retardation Board of Dallas, Perry and Wilcox Counties | Cahaba Region Mental Health Center |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State