| 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 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
