| Name: | Shadescrest Health Care Center |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 20 Nov 1970 (54 years ago) |
| Entity Number: | 000-014-473 |
| Register Number: | 000014473 |
| Historical Names: |
Peoples Nursing Home
|
| County: | Walker |
| Place of Formation: | Walker County |
| Principal Address: | JASPER, AL |
| Registered Office Street Address: | 331 25TH ST WJASPER, AL 35501 |
| Registered Office Street Address ZIP Code: | 35501 |
| Authorized Capital: | $25,000 |
| Paid Share Capital: | $5,000 |
Activities
OPERATE NURSING HOME
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SA9KBZWW4MK7 | 2025-01-09 | 331 25TH ST W, JASPER, AL, 35501, 5828, USA | P.O. BOX 1012, JASPER, AL, 35502, 1012, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Congressional District | 04 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2024-01-12 |
| Initial Registration Date | 2008-11-19 |
| Entity Start Date | 1976-09-15 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 623110 |
| Product and Service Codes | Q402 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | JENNIFER MORROW |
| Role | ASSISTANT ADMINISTRATOR |
| Address | 331 25TH ST WEST, JASPER, AL, 35501, USA |
| Title | ALTERNATE POC |
| Name | MONICA MORGAN |
| Role | BOM |
| Address | 331 25TH STREET WEST, JASPER, AL, 35502, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | CHESTER MUMPOWER |
| Role | ADMINISTRATOR |
| Address | 331 25TH ST WEST, JASPER, AL, 35501, USA |
| Title | ALTERNATE POC |
| Name | CHESTER MUMPOWER |
| Role | ADMINISTRATOR |
| Address | 331 25TH STREET WEST, JASPER, AL, 35502, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | CHESTER MUMPOWER |
| Role | ADMINISTRATOR |
| Address | 331 25TH STREET WEST, JASPER, AL, 35502, USA |
| Title | ALTERNATE POC |
| Name | MARK WEST |
| Role | CFO |
| Address | 331 25TH ST WEST, JASPER, AL, 35501, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073500831 | 2005-10-05 | 2022-01-19 | 331 25TH ST W, P.O. BOX 1012, JASPER, AL, 355015828, US | 331 25TH ST W, JASPER, AL, 355015828, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 205-384-9086 |
| Fax | 2053872225 |
Authorized person
| Name | MR. JOE B HAVENS |
| Role | ADMINISTRATOR |
| Phone | 2053849086 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10671 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4754101S |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 595C6 | Active | Non-Manufacturer | 2008-11-20 | 2024-01-12 | 2029-01-12 | 2025-01-09 | |||||||||||||||
|
|||||||||||||||||||||
| POC | CHESTER MUMPOWER |
| Phone | +1 205-384-9086 |
| Fax | +1 205-384-5684 |
| Address | 331 25TH ST W, JASPER, AL, 35501 5828, 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 |
|---|
| Name | Role |
|---|---|
| BENSON, HAROLD | Incorporator |
| BENSON, MARGARET | Incorporator |
| PRUITT, HARRY D | Incorporator |
| GWIN, CAREY DR | Incorporator |
| WEAVER, GEORGE H DR | Incorporator |
| Name | Role |
|---|---|
| STOUT, HELEN LOUISE | Agent |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1976-09-15 | Name Change | Peoples Nursing Home | Shadescrest Health Care Center |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | 36C24724K0078 | 2024-06-01 | 2024-06-30 | 2024-06-30 | |||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||
| Obligated Amount | 117780.37 |
| Current Award Amount | 117780.37 |
| Potential Award Amount | 117780.37 |
Description
| Title | EXPRESS REPORT: JUN 2024 |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | SHADESCREST HEALTH CARE CENTER |
| UEI | SA9KBZWW4MK7 |
| Recipient Address | UNITED STATES, 331 25TH ST W, JASPER, WALKER, ALABAMA, 355015828 |
| Unique Award Key | CONT_AWD_36C24724K0074_3600_36C24723D0012_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 338044.96 |
| Current Award Amount | 338044.96 |
| Potential Award Amount | 338044.96 |
Description
| Title | EXPRESS REPORT: FY24 MAR-MAY |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | SHADESCREST HEALTH CARE CENTER |
| UEI | SA9KBZWW4MK7 |
| Recipient Address | UNITED STATES, 331 25TH ST W, JASPER, WALKER, ALABAMA, 355015828 |
| Unique Award Key | CONT_AWD_36C24724K0046_3600_36C24723D0012_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 279194.15 |
| Current Award Amount | 279194.15 |
| Potential Award Amount | 279194.15 |
Description
| Title | EXPRESS REPORT: FY24 2ND QTR (JAN-FEB) |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: MEDICAL- NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SHADESCREST HEALTH CARE CENTER |
| UEI | SA9KBZWW4MK7 |
| Recipient Address | UNITED STATES, 331 25TH ST W, JASPER, WALKER, ALABAMA, 355015828 |
| Unique Award Key | CONT_IDV_36C24723D0012_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 5987453.40 |
Description
| Title | COMMUNITY NURSING HOME CARE SERVICES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | SHADESCREST HEALTH CARE CENTER |
| UEI | SA9KBZWW4MK7 |
| Recipient Address | UNITED STATES, 331 25TH ST W, JASPER, WALKER, ALABAMA, 355015828 |
| Unique Award Key | CONT_IDV_VA247BO0058_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 0.00 |
Description
| Title | NURSING HOME |
| NAICS Code | 623110: NURSING CARE FACILITIES |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SHADESCREST HEALTH CARE CENTER |
| UEI | SA9KBZWW4MK7 |
| Recipient Address | UNITED STATES, 2600 PARRISH HWY, JASPER, WALKER, ALABAMA, 355010000 |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
