| Name: | Forest Manor, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 29 Apr 1975 (50 years ago) |
| Date of dissolution: | 02 Dec 2021 |
| Entity Number: | 000-037-448 |
| Register Number: | 000037448 |
| Place of Formation: | Tuscaloosa County |
| Authorized Capital: | 10,000 @ $10PV |
| Paid Share Capital: | $2,000 |
Activities
OPERATE NURSING HOMES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336129402 | 2006-01-17 | 2020-08-22 | 2215 32ND ST, NORTHPORT, AL, 354765230, US | 2215 32ND ST, NORTHPORT, AL, 354765230, US | |||||||||||||||||||||||||
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| Phone | +1 205-339-5400 |
| Fax | 2053393455 |
Authorized person
| Name | MRS. SUSAN WILLIAMS |
| Role | ADMINISTRATOR |
| Phone | 2053395400 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10665 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4754720S |
| State | AL |
| Name | Role |
|---|---|
| PEAK, DONALD W | Incorporator |
| PEAK, ANN S | Incorporator |
| PEAK, C A | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2011-10-25 | Capital Change | $2,000 Authorized $2,000 Paid In | 10,000 @ $10PV Authorized $2,000 Paid In |
Date of last update: 30 Jul 2024
Sources: Alabama Secretary of State
