| NAME |
ZZ-DOTHAN MENTAL HLT CLNC |
| STATE |
ALABAMA |
| STREET ADDR. 1 |
3753 ROSS CLARK CIRCLE, SUITE 4 |
| CITY |
DOTHAN |
| ZIP |
36303-2295 |
| OFFICIAL VA NAME |
DOTHAN MENTAL HLT CLNC |
| INACTIVE FACILITY FLAG |
INACTIVE |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
DOTHAN MENTAL HEALTH VA CBOC |
| ST. ADDR. 1 (MAILING) |
3753 ROSS CLARK CIRCLE, SUITE 4 |
| CITY (MAILING) |
DOTHAN |
| STATE (MAILING) |
ALABAMA |
| ZIP (MAILING) |
36303-2295 |
| EFFECTIVE DATE/TIME |
-
- 2007-11-06 00:00:00
- STATUS: ACTIVE
- NPI: 1497809289
-
- 2020-04-06 00:00:00
- STATUS: INACTIVE
- NPI: 1497809289
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
619GC |
| IDENTIFIER |
-
- CODING SYSTEM: VASTANUM
- ID: 619GC
|
