Provider Demographics
NPI:1962540922
Name:BALDWIN COUNTY MENTAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:BALDWIN COUNTY MENTAL HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOC DIR OF TECH SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:ARBOUR
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:251-990-4203
Mailing Address - Street 1:372 S GREENO RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1916
Mailing Address - Country:US
Mailing Address - Phone:251-928-2871
Mailing Address - Fax:251-928-0126
Practice Address - Street 1:372 S GREENO RD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1916
Practice Address - Country:US
Practice Address - Phone:251-928-2871
Practice Address - Fax:251-928-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL251B00000X, 251S00000X, 261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051008122OtherBCBS ALABAMA
AL330000003Medicaid
AL051008122OtherBCBS ALABAMA