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Self Health Care & Rehab Center, Inc.

Details

Name: Self Health Care & Rehab Center, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 23 Nov 2004 (20 years ago) (Companies founded in November 2004)
Entity Number: 000-238-436
Register Number: 000238436
ZIP code: 35023 (Companies in Jefferson, 35023)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: HUEYTOWN, AL
Registered Office Street Address: 131 CREST RDHUEYTOWN, AL 35023
Authorized Capital: $100

Activities LEASE/OPERATE A HEALTHCARE/REHABILITATION CENTER

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1235114901 2005-12-14 2012-04-05 131 E CREST RD, HUEYTOWN, AL, 350231623, US 131 E CREST RD, HUEYTOWN, AL, 350231623, US

Contacts

Phone +1 205-491-2411
Fax 2054918750

Authorized person

Name J A SELF JR.
Role OWNER ADMINISTRATOR
Phone 2054912411

Taxonomy

Taxonomy Code 314000000X - Skilled Nursing Facility
License Number 11106
State AL
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 4753430S
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2020 320133776 2021-02-17 SELF HEALTH CARE & REHAB CENTER, INC. 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2021-02-17
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2019 320133776 2020-03-03 SELF HEALTH CARE & REHAB CENTER, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2020-03-03
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2020-03-03
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2018 320133776 2019-02-27 SELF HEALTH CARE & REHAB CENTER, INC. 72
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2019-02-27
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2019-02-27
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2017 320133776 2018-02-16 SELF HEALTH CARE & REHAB CENTER, INC. 64
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2018-02-16
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2018-02-16
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2016 320133776 2017-03-10 SELF HEALTH CARE & REHAB CENTER, INC. 61
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2017-03-10
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2017-03-10
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2015 320133776 2016-06-21 SELF HEALTH CARE & REHAB CENTER, INC. 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2016-06-21
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2016-06-21
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2014 320133776 2015-02-27 SELF HEALTH CARE & REHAB CENTER, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2015-02-27
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2015-02-27
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2013 320133776 2014-03-13 SELF HEALTH CARE & REHAB CENTER, INC. 66
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2014-03-13
Name of individual signing ANDY SELF
Role Employer/plan sponsor
Date 2014-03-13
Name of individual signing ANDY SELF
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2012 320133776 2013-01-31 SELF HEALTH CARE & REHAB CENTER, INC. 69
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Signature of

Role Plan administrator
Date 2013-01-31
Name of individual signing DEB SAVINCKI
Role Employer/plan sponsor
Date 2013-01-31
Name of individual signing DEB SAVINCKI
SELF HEALTH CARE & REHAB CENTER, INC. 401(K) RETIREMENT PLAN 2011 320133776 2012-03-20 SELF HEALTH CARE & REHAB CENTER, INC. 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1994-01-01
Business code 623000
Sponsor’s telephone number 2054912411
Plan sponsor’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506

Plan administrator’s name and address

Administrator’s EIN 320133776
Plan administrator’s name SELF HEALTH CARE & REHAB CENTER, INC.
Plan administrator’s address 131 CREST ROAD, HUEYTOWN, AL, 350231506
Administrator’s telephone number 2054912411

Signature of

Role Plan administrator
Date 2012-03-20
Name of individual signing DEBRA SAVINCKI
Role Employer/plan sponsor
Date 2012-03-20
Name of individual signing DEBRA SAVINCKI

Agent

Name Role
SELF, JASPER A JR Agent

Incorporator

Name Role Address
MCCLANAHAN, RANDALL D Incorporator 1819 FIFTH AVE N STE 1000BIRMINGHAM, AL 35203

Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State