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Azalea City Medical Services, Inc.

Details

Name: Azalea City Medical Services, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 12 Aug 1997 (27 years ago)
Entity Number: 000-189-454
Register Number: 000189454
County: Mobile
Place of Formation: Mobile County
Principal Address: SARALAND, AL
Registered Office Street Address: 306-E SHELTON BEACH ROADSARALAND, AL 36571
Registered Office Street Address ZIP Code: 36571
Authorized Capital: $1,000

Activities ANY LAWFUL ACTIVITY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1568682078 2007-04-26 2014-10-31 3046 DAUPHIN ISLAND PKWY, MOBILE, AL, 366053835, US 3046 DAUPHIN ISLAND PKWY, MOBILE, AL, 366053835, US

Contacts
Phone +1 251-287-7067
Fax 2514616439

Authorized person
Name DEBBIE KING
Role OWNERPRESIDENT
Phone 2512877067

Taxonomy
Taxonomy Code 251E00000X - Home Health Agency
License Number 111612
State AL
Is Primary Yes
Taxonomy Code 251F00000X - Home Infusion Agency
License Number 111612
State AL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 100003585
State AL
Issuer BLUECROSSBLUE
Number 51516978
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2017 721394851 2018-08-27 AZALEA CITY MEDICAL SERVICES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621610
Sponsor’s telephone number 2512877065
Plan sponsor’s address 3046 DAUPHIN ISLAND PARKWAY, MOBILE, AL, 36605
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2016 721394851 2017-10-16 AZALEA CITY MEDICAL SERVICES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621610
Sponsor’s telephone number 2512877065
Plan sponsor’s address 3046 DAUPHIN ISLAND PARKWAY, MOBILE, AL, 36605
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2015 721394851 2016-10-11 AZALEA CITY MEDICAL SERVICES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621610
Sponsor’s telephone number 2512877065
Plan sponsor’s address 3046 DAUPHIN ISLAND PARKWAY, MOBILE, AL, 36605
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2014 721394851 2015-10-13 AZALEA CITY MEDICAL SERVICES, INC. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 3046 DAUPHIN ISLAND PARKWAY, MOBILE, AL, 36605

Signature of
Role Plan administrator
Date 2015-10-13
Name of individual signing DEBORAH O. KING
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2013 721394851 2014-05-20 AZALEA CITY MEDICAL SERVICES, INC. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604

Plan administrator’s name and address
Administrator’s EIN 721394851
Plan administrator’s name AZALEA CITY MEDICAL SERVICES, INC.
Plan administrator’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604
Administrator’s telephone number 2514386860

Signature of
Role Plan administrator
Date 2014-05-20
Name of individual signing DEBORAH O. KING
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2012 721394851 2013-10-11 AZALEA CITY MEDICAL SERVICES, INC. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604

Plan administrator’s name and address
Administrator’s EIN 721394851
Plan administrator’s name AZALEA CITY MEDICAL SERVICES, INC.
Plan administrator’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604
Administrator’s telephone number 2514386860

Signature of
Role Plan administrator
Date 2013-10-11
Name of individual signing DEBORAH O. KING
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2011 721394851 2012-07-30 AZALEA CITY MEDICAL SERVICES, INC. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604

Plan administrator’s name and address
Administrator’s EIN 721394851
Plan administrator’s name AZALEA CITY MEDICAL SERVICES, INC.
Plan administrator’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604
Administrator’s telephone number 2514386860

Signature of
Role Plan administrator
Date 2012-07-30
Name of individual signing DEBORAH O. KING
AZALEA CITY MEDICAL SERVICES, INC. 401(K) PROFIT SHARING PLAN 2010 721394851 2011-10-12 AZALEA CITY MEDICAL SERVICES, INC. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604

Plan administrator’s name and address
Administrator’s EIN 721394851
Plan administrator’s name AZALEA CITY MEDICAL SERVICES, INC.
Plan administrator’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604
Administrator’s telephone number 2514386860

Signature of
Role Plan administrator
Date 2011-10-12
Name of individual signing DEBORAH O. KING
AZALEA CITY MEDICAL SERVICES, INC., 401K PROFIT SHARING PLAN 2009 721394851 2010-10-11 AZALEA CITY MEDICAL SERVICES, INC. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2007-01-01
Business code 621610
Sponsor’s telephone number 2514386860
Plan sponsor’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604

Plan administrator’s name and address
Administrator’s EIN 721394851
Plan administrator’s name AZALEA CITY MEDICAL SERVICES, INC.
Plan administrator’s address 1359 SPRINGHILL AVENUE, MOBILE, AL, 36604
Administrator’s telephone number 2514386860

Signature of
Role Plan administrator
Date 2010-10-11
Name of individual signing DEBORAH O. KING

Incorporator

Name Role
KING, ANDREW W Incorporator
KING, DEBORAH O Incorporator

Agent

Name Role
KING, ANDREW W Agent

Related by officers

No related officers

Related by address

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Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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