| Name: | Cloverdale Health Care, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 17 Mar 2000 (25 years ago) |
| Entity Number: | 000-208-721 |
| Register Number: | 000208721 |
| County: | Blount |
| Place of Formation: | Blount County |
| Principal Address: | ONEONTA, AL |
| Registered Office Street Address: | 111 1ST AVENUE EASTONEONTA, AL 35121 |
| Registered Office Street Address ZIP Code: | 35121 |
| Authorized Capital: | $1,000 |
| Paid Share Capital: | $1,000 |
Activities
SKILLED NURSING/REHAB/ASSISTED LIVING/HEALTHCARE FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922004811 | 2005-06-24 | 2017-06-06 | 412 W CLOVERDALE RD, SCOTTSBORO, AL, 357684264, US | 412 W CLOVERDALE RD, SCOTTSBORO, AL, 357684264, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 256-259-1505 |
| Fax | 2562594279 |
Authorized person
| Name | MRS. KRISTY A JONES |
| Role | ADMINISTRATOR |
| Phone | 2562591505 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10541 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4753350S |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD AL |
| Number | 011620 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| SIMS, MARK S | Agent | 111 FIRST AVENUE EASTONEONTA, AL 35121 |
| Name | Role | Address |
|---|---|---|
| SIMS, MARK S | Incorporator | 111 FIRST AVENUE EASTONEONTA, AL 35121 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
