| 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) |
| Date of dissolution: | 08 Aug 2023 |
| Entity Number: | 000-557-903 |
| Register Number: | 000557903 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 940 MONTCLAIR RD STE 200BIRMINGHAM, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
Activities
RELIGIOUS/CHARITABLE/SCIENTIFIC/LITERARY/EDUCATIONAL PURPOSES
| 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 | |||||||||||||||||||||
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| 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 |
| 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 | |||||||||||||||
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| 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 |
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| 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 | |||||||||||||||||||||||||||||
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| 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 |
| Name | Role | Address |
|---|---|---|
| CRAIG, RICHARD | Agent | 940 MONTCLAIR RD STE 200BIRMINGHAM, AL 35213 |
| 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
