| Name: | Russellville Health Care, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Merged |
| Date of registration: | 22 Nov 1988 (36 years ago) (Companies founded in November 1988) |
| Entity Number: | 000-127-505 |
| Register Number: | 000127505 |
| Historical Names: |
Russellville Health Care, Inc.
|
| ZIP code: | 35121 (Companies in Blount, 35121) |
| County: | Blount |
| Place of Formation: | Blount County |
| Registered Office Street Address: | 110 2ND AVE EASTONEONTA, AL 35121 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326120502 | 2006-10-19 | 2022-08-26 | 705 GANDY ST NE, RUSSELLVILLE, AL, 356531913, US | 705 GANDY ST NE, RUSSELLVILLE, AL, 356531913, US | |||||||||||||||||||||||||
|
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| Phone | +1 256-332-3773 |
| Fax | 2563321292 |
Authorized person
| Name | MRS. BRENDA GAIL HOVATER |
| Role | NURSING HOME ADMINISTRATOR |
| Phone | 2563323773 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12541 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4750710 |
| State | AL |
| Name | Role |
|---|---|
| HUIE, JOHN D | Agent |
| Name | Role | Address |
|---|---|---|
| LOFTIN, ROBERT L III | Organizer | 800 SHADES CREEK PKWY, STE 400BIRMINGHAM, AL 35209 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2016-11-14 | Name Change | Russellville Health Care, Inc. | Russellville Health Care, LLC |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
