| Name: | Lake Martin Hospice, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Jul 2014 (10 years ago) (Companies founded in July 2014) |
| Entity Number: | 000-313-544 |
| Register Number: | 000313544 |
| ZIP code: | 36853 (Companies in Tallapoosa, 36853) |
| County: | Tallapoosa |
| Place of Formation: | Tallapoosa County |
| Principal Address: | 201 MARIARDEN RDDADEVILLE, AL 36853 |
Activities
HEALTH CARE SERVICES AND MEDICAL SUPPLIES
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Q6BYQAHPENN6 | 2023-12-05 | 201 MARIARDEN RD, DADEVILLE, AL, 36853, 6244, USA | 201 MARIARDEN ROAD, DADEVILLE, AL, 36853, USA | |||||||||||||||||||||||||||||||||||||||||||||
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| Doing Business As | IVY CREEK HOSPICE |
| Division Name | LAKE MARTIN HOSPICE LLC |
| Congressional District | 03 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2022-12-07 |
| Initial Registration Date | 2021-11-19 |
| Entity Start Date | 2018-12-18 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621399, 621610 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | TROY LANGLEY |
| Role | DIRECTOR |
| Address | 5746 MARLINE ROAD SUITE 60, CHATTANOOGA, TN, 37411, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | LINDA SEGREST |
| Role | DIRECTOR |
| Address | 201 MARIARDEN ROAD, DADEVILLE, AL, 36092, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346305216 | 2006-12-22 | 2018-03-29 | 201 MARIARDEN RD, DADEVILLE, AL, 368536244, US | 201 MARIARDEN RD, DADEVILLE, AL, 368536244, US | |||||||||||||||||||||
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| Phone | +1 256-825-3272 |
| Fax | 2568258578 |
Authorized person
| Name | MICHAEL D BRUCE |
| Role | CEO |
| Phone | 2568254785 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PIC1621E |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BRUCE, MICHAEL | Agent | 42 MALCOLM AVENUE SWRAINSVILLE, AL 35986 |
| Name | Role |
|---|---|
| IVY CREEK HOME HEALTH LLC | Member |
| Name | Role | Address |
|---|---|---|
| IVY CREEK HEALTH CARE LLC | Organizer | 16020 SOUTH WEST 80TH AVEMIAMI, FL 33157 |
| BRUCE, MICHAEL | Organizer | 42 MALCOLM AVENUE SWRAINSVILLE, AL 35986 |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
