| Name: | Homestead Hospice of Southwest Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Oct 2013 (11 years ago) (Companies founded in October 2013) |
| Entity Number: | 000-290-738 |
| Register Number: | 000290738 |
| ZIP code: | 36908 (Companies in Choctaw, 36908) |
| County: | Choctaw |
| Place of Formation: | Georgia |
| Principal Address: | 10888 CRABAPPLE ROADROSWELL, GA 30075 |
| Registered Office Street Address: | 128 FRONT STREETGILBERTOWN, AL 36908 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386075927 | 2013-12-09 | 2015-06-29 | 10888 CRABAPPLE RD, ROSWELL, GA, 300755850, US | 13456 CHOCTAW AVE, GILBERTOWN, AL, 369089502, US | |||||||||||||||||||||||||||||
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| Phone | +1 678-966-0077 |
| Fax | 6783673718 |
| Phone | +1 251-843-3151 |
| Fax | 2518433158 |
Authorized person
| Name | MS. JEANNE PETE |
| Role | VP |
| Phone | 7708256550 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | E1205 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 158932 |
| State | AL |
| Name | Role |
|---|---|
| WEEKS, ROBERT P | Agent |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
