| Name: | The Health Care Authority of Elba, Alabama |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 01 Jun 1983 (41 years ago) |
| Entity Number: | 000-271-941 |
| Register Number: | 000271941 |
| Place of Formation: | Coffee County |
Activities
HEALTH CARE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114904968 | 2005-12-22 | 2012-04-05 | 987 DRAYTON AVE, ELBA, AL, 363231402, US | 987 DRAYTON AVE, ELBA, AL, 363231402, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-897-2257 |
| Fax | 3348971213 |
Authorized person
| Name | MR. CHRIS NOLAND |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 3348972257 |
Taxonomy
| Taxonomy Code | 282NR1301X - Rural Acute Care Hospital |
| License Number | 10328 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 143 |
| State | AL |
| Issuer | MEDICAID |
| Number | HOS0027H |
| State | AL |
| Name | Role | Address |
|---|---|---|
| COOK, J D | Director | PINDALE DRIVEELBA, AL 36323 |
| BRUNSON, CAROLYN | Director | 975 BROOKDALEELBA, AL 36323 |
| HICKMAN, CLAYTON | Director | CLARK CIRCLEELBA, AL 36323 |
| COLEMAN, VIRGIL | Director | No data |
| DORSEY, PETE | Director | No data |
| Name | Role | Address |
|---|---|---|
| COOK, J D | Incorporator | PINDALE DRIVEELBA, AL 36323 |
| BRUNSON, CAROLYN | Incorporator | 975 BROOKDALEELBA, AL 36323 |
| HICKMAN, CLAYTON | Incorporator | CLARK CIRCLEELBA, AL 36323 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
