| Name: | Erin Hanover, M.D. LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 01 Apr 2011 (14 years ago) |
| Date of dissolution: | 11 May 2021 |
| Entity Number: | 000-008-618 |
| Register Number: | 000008618 |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Registered Office Street Address: | 116 HOLLAND TRAILPELHAM, AL 35124 |
| Registered Office Street Address ZIP Code: | 35124 |
Activities
HEALTH CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710274741 | 2011-06-28 | 2011-06-28 | 116 HOLLAND TRL, PELHAM, AL, 351243973, US | 200 CHASE PARK S, SUITE 102, BIRMINGHAM, AL, 352441884, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-767-0564 |
| Fax | 2059870725 |
| Phone | +1 205-987-0724 |
Authorized person
| Name | DR. ERIN EMMANUEL HANOVER |
| Role | SOLE PROPRIETOR |
| Phone | 2057670564 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| License Number | MD.29132 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI TYPE 1 |
| Number | 1073716064 |
| State | AL |
| Issuer | MEDICAID |
| Number | R9629 |
| State | AL |
| Name | Role |
|---|---|
| HANOVER, ERIN E | Agent |
| Name | Role | Address |
|---|---|---|
| MERSHON, CHRIS | Organizer | 187 E WARM SPRINGS ROAD SUITE BLAS VEGAS, NV 89119 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
