| Name: | Northport Hospital - DCH, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Mar 1992 (33 years ago) |
| Date of dissolution: | 05 Jun 1992 |
| Entity Number: | 000-148-404 |
| Register Number: | 000148404 |
| Historical Names: |
Amisub (WAGH), Inc.
|
| County: | Tuscaloosa |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 809 UNIVERSITY BOULEVARDTUSCALOOSA, AL 35403 |
| Registered Office Street Address ZIP Code: | 35403 |
| Authorized Capital: | $1,000 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497999700 | 2009-04-30 | 2021-01-22 | 1820 RICE MINE RD N, SUITE 200, TUSCALOOSA, AL, 354063281, US | 2702 HOSPITAL DR, SUITE 201, NORTHPORT, AL, 354763397, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 205-333-4655 |
| Fax | 2053334660 |
| Phone | +1 205-333-4522 |
Authorized person
| Name | KERI HINDMAN |
| Role | PATIENT ACCOUNTS DIRECTOR |
| Phone | 2057597378 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE RAILROAD |
| Number | CA6681 |
| State | AL |
| Issuer | MEDICAID |
| Number | 110667 |
| State | AL |
| Name | Role |
|---|---|
| FORD, JAMES H JR | Agent |
| Name | Role |
|---|---|
| SECREST, STEPHANIE | Incorporator |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1992-05-29 | Name Change | Amisub (WAGH), Inc. | Northport Hospital - DCH, Inc. |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
