| Name: | Gulf Coast Health and Rehabilitation, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Mar 2013 (12 years ago) (Companies founded in March 2013) |
| Entity Number: | 000-073-703 |
| Register Number: | 000073703 |
| ZIP code: | 35203 (Companies in Jefferson, 35203) |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 420 NORTH 20TH STREET AUITE 3400BIRMINGHAM, AL 35203 |
Activities
SKILLED CARE NURSING FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366880783 | 2013-06-07 | 2020-10-28 | 8002 GRELOT RD, MOBILE, AL, 366958976, US | 8002 GRELOT RD, MOBILE, AL, 366958976, US | |||||||||||||||||||||
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| Phone | +1 251-634-8002 |
| Fax | 2514452551 |
Authorized person
| Name | PHILLIP CODY LONG |
| Role | VICE PRESIDENT |
| Phone | 2053913600 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 152557 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role | Address |
|---|---|---|
| SPRAGUE, ROBERT | Organizer | 931 FAIRFAX PARKTUSCALOOSA, AL 35406 |
| HELMS, ANITA | Organizer | 931 FAIRFAX PARKTUSCALOOSA, AL 35406 |
| CRANE, CONNIE | Organizer | 931 FAIRFAX PARKTUSCALOOSA, AL 35406 |
| STEPHENSON, JACK P | Organizer | 420 NORTH 20TH STREET SUITE 3400BIRMINGHAM, AL 35203 |
Date of last update: 31 Jul 2024
Sources: Alabama Secretary of State
