| Name: | Integrated Behavioral Health, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 20 Mar 2013 (12 years ago) |
| Entity Number: | 000-278-360 |
| Register Number: | 000278360 |
| County: | Madison |
| Place of Formation: | Limestone County |
| Registered Office Street Address: | 25850 MAIN STREETARDMORE, TN 38449 |
| Principal Address: | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| Principal Address ZIP Code: | 35758 |
| Authorized Capital: | 1,000 @ $1.00PV |
Activities
MEDICAL AND PSYCHOLOGICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730522699 | 2013-04-10 | 2019-08-26 | 600 SUN TEMPLE DRIVE, MADISON, AL, 357585919, US | 600 SUN TEMPLE DRIVE, MADISON, AL, 357585919, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-288-3333 |
| Fax | 2562883334 |
Authorized person
| Name | KELLI HARDIN |
| Role | DIRECTOR OF CREDENTIALING |
| Phone | 2562883333 |
Taxonomy
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | No |
| Taxonomy Code | 104100000X - Social Worker |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0805X - Geriatric Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| INTEGRATED BEHAVIORAL HEALTH 401(K) PLAN | 2020 | 462336113 | 2021-10-06 | INTEGRATED BEHAVIORAL HEALTH | 105 | |||||||||||||
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| INTEGRATED BEHAVIORAL HEALTH 401(K) PLAN | 2019 | 462336113 | 2020-10-14 | INTEGRATED BEHAVIORAL HEALTH | 95 | |||||||||||||
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| INTEGRATED BEHAVIORAL HEALTH 401(K) PLAN | 2018 | 462336113 | 2019-10-14 | INTEGRATED BEHAVIORAL HEALTH | 76 | |||||||||||||
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| INTEGRATED BEHAVIORAL HEALTH 401(K) PLAN | 2017 | 462336113 | 2018-10-12 | INTEGRATED BEHAVIORAL HEALTH | 49 | |||||||||||||
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| Name | Role | Address |
|---|---|---|
| MALHOTRA, SANJAY | Agent | 108 MICHIGAN COURTMADISON, AL 35758 |
| Name | Role | Address |
|---|---|---|
| MALHOTRA, SANJAY | Director | 108 MICHIGAN COURTMADISON, AL 35758 |
| JENNINGS, JEFF | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| CARPENTER, TIMOTHY | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| WHALEN, TIMOTHY | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| MAHAFFEY, BRYANT | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| HAMMOND, JOHN | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| MALHOTRA, KAMAL | Director | 600 SUN TEMPLE DRIVEMADISON, AL 35758 |
| Name | Role | Address |
|---|---|---|
| MALHOTRA, SANJAY | Incorporator | 108 MICHIGAN COURTMADISON, AL 35758 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
