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Western Mental Health Center, Inc.

Details

Name: Western Mental Health Center, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Dissolved
Date of registration: 06 Mar 2003 (22 years ago) (Companies founded in March 2003)
Date of dissolution: 08 Aug 2023
Entity Number: 000-557-903
Register Number: 000557903
ZIP code: 35213 (Companies in Jefferson, 35213)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 940 MONTCLAIR RD STE 200BIRMINGHAM, AL 35213

Activities RELIGIOUS/CHARITABLE/SCIENTIFIC/LITERARY/EDUCATIONAL PURPOSES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1659548444 2008-05-12 2008-05-12 1701 AVENUE D, BIRMINGHAM, AL, 352181532, US 1701 AVENUE D, BIRMINGHAM, AL, 352181532, US

Contacts

Phone +1 205-788-7770
Fax 2057887552

Authorized person

Name DR. TOM RAY HOBBS
Role EXECUTIVE DIRECTOR
Phone 2057887770

Taxonomy

Taxonomy Code 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 330000006
State AL

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
72KF5 Obsolete Non-Manufacturer 2014-02-27 2021-12-31 2021-12-30 No data

Contact Information

POC CLIFFORD A. WRIGHT
Phone +1 205-788-7770
Fax +1 205-788-7552
Address 1701 AVE D, BIRMINGHAM, AL, 35218 1532, UNITED STATES

Ownership of Offeror Information

Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
WESTERN MENTAL HEALTH 2009 562334962 2010-07-02 WESTERN MENTAL HEALTH CENTER 65
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621112
Sponsor’s telephone number 2057887770
Plan sponsor’s address 1701 AVENUE D, BIRMINGHAM, AL, 35218

Plan administrator’s name and address

Administrator’s EIN 562334962
Plan administrator’s name WESTERN MENTAL HEALTH CENTER
Plan administrator’s address 1701 AVENUE D, BIRMINGHAM, AL, 35218
Administrator’s telephone number 2057887770

Signature of

Role Plan administrator
Date 2010-07-02
Name of individual signing WESTERN MENTAL HEALTH CENTER

Agent

Name Role Address
CRAIG, RICHARD Agent 940 MONTCLAIR RD STE 200BIRMINGHAM, AL 35213

Incorporator

Name Role Address
BRICKMAN, STEVEN A Incorporator 2311 HIGHLAND AVENUE SOUTH SUITE 500BIRMINGHAM, AL 35205

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State