| Name: | Lifestar Response of Alabama, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 25 Mar 1997 (28 years ago) |
| Date of dissolution: | 04 Jun 2021 |
| Entity Number: | 000-186-575 |
| Register Number: | 000186575 |
| County: | Montgomery |
| Place of Formation: | Henry County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| Authorized Capital: | $100 |
Activities
GENERAL PRIVATE AMBULANCE SERVICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285621797 | 2005-09-29 | 2018-03-02 | PO BOX 530481, ATLANTA, GA, 303530481, US | 1150 PANAMA ST. SOUTH, MONTGOMERY, AL, 361072704, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 888-876-2100 |
| Fax | 8887900688 |
| Phone | +1 800-449-4911 |
| Fax | 3342622538 |
Authorized person
| Name | MR. CHARLES MAYMON |
| Role | REGIONAL CEO |
| Phone | 9548686668 |
Taxonomy
| Taxonomy Code | 3416L0300X - Land Ambulance |
| License Number | 003074 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 3416L0300X - Land Ambulance |
| License Number | 1039 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 200051103 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 6190 POWERS FERRY RD STE 600ATLANTA, GA 30339 |
| Name | Role | Address |
|---|---|---|
| PETERSON, DEREK | Incorporator | 4009 OLD SHELL RD A-10MOBILE, AL 36608 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
