| Name: | Senior Health Source LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Mar 2011 (14 years ago) |
| Entity Number: | 000-005-842 |
| Register Number: | 000005842 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | 107 NICOLE PLACEDAPHNE, AL 36526 |
| Principal Address ZIP Code: | 36526 |
Activities
PROVIDE HEALTH CARE SERVICES BY NURSE PRACTITIONERS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750677407 | 2011-06-21 | 2011-12-30 | PO BOX 7872, SPANISH FORT, AL, 365777872, US | 27440 COUNTY ROAD 13, DAPHNE, AL, 365266222, US | |||||||||||||||||
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| Phone | +1 251-533-6372 |
Authorized person
| Name | MRS. KAREN L JACKSON |
| Role | OWNER |
| Phone | 2515336372 |
Taxonomy
| Taxonomy Code | 364SG0600X - Gerontology Clinical Nurse Specialist |
| License Number | 1-087343 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JACKSON, KAREN L | Organizer | 107 NICOLE PLACEDAPHNE, AL 36526 |
| JACKSON, RONALD L | Organizer | 25933 KENSINGTON WAYDAPHNE, AL 36526 |
| Name | Role | Address |
|---|---|---|
| JACKSON, RONALD L | Agent | 25933 KENSINGTON WAYDAPHNE, AL 36526 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
