Alabama HealthCare Advantage South, Inc.

Details

Name:	Alabama HealthCare Advantage South, Inc.
Jurisdiction:	Alabama
Legal type:	Domestic Non-Profit Corporation
Status:	Dissolved
Date of registration:	17 Jul 2014 (10 years ago)
Date of dissolution:	14 Apr 2017
Entity Number:	000-314-166
Register Number:	000314166
Historical Names:	Alabama Healthcare Advantage South LLC
County:	Montgomery
Place of Formation:	Montgomery County
Registered Office Street Address:	2740 ZELDA ROADMONTGOMERY, AL 36106
Registered Office Street Address ZIP Code:	36106
Principal Address:	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
Principal Address ZIP Code:	36117

Activities TO BECOME A MEDICAID RCO IN ALABAMA REGION E

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1942665666

2015-12-22

8650 MINNIE BROWN RD STE 224, MONTGOMERY, AL, 361177433, US

Contacts

Phone

+1 334-215-3985

Authorized person

Taxonomy

Taxonomy Code	251K00000X - Public Health or Welfare Agency
Is Primary	Yes

Name	Role	Address
MOORE, BRIAN W	Agent	2740 ZELDA ROADMONTGOMERY, AL 36106

Name	Role	Address
WHITNEY, TODD	Director	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
CAMERIO, MICHAEL L	Director	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
ENSLEY, RICHARD	Director	223 DRIFTWOOD LANETALLASSEE, AL 36078
REDDEN, JOHN	Director	231 WALBASH DRIVEMONTGOMERY, AL 36116
TAYLOR, DOUG	Director	7472 SOUTH TUSCON WAY SUITE 100CENTENNIAL, CO 80112
BABCOCK, ALAN	Director	10721 RED FERN ROADDAPHNE, AL 36526
FULGHAM, HENRY	Director	1515 UNIVERSITY BOULEVARD SOUTHMOBILE, AL 36609
FULGHAM, PHILLIP	Director	1515 UNIVERSITY BLVD SOUTHMOBILE, AL 36609
EICHOLD, BERNARD	Director	No data
JOINER, SARAH	Director	6901 AIRPORT BLVDMOBILE, AL 36608-3795
SKINNER, LESLIE	Director	19087B GREENO ROADFAIRHOPE, AL 36532-3899
HICKS, JEFF	Director	1127 HIGHWAY 43 SOUTHSARALAND, AL 36571
LOVE, ROBERT STEVEN	Director	8852 ESCAMBIA AVENUEPERDIDO BEACH, AL 36530
NELSON, STEVE	Director	2560 MIDDLE RDMOBILE, AL 36605
VAUGHN, STEPHANIE	Director	5741 VENDOMB DRIVE SOUTHMOBILE, AL 36609
PATCHEN, JASON	Director	3505 E FRONTAGE ROAD, STE 250TAMPA, FL 33607
BALL, CLARENCE	Director	SERVICES ONE SOUTHERN WAYMOBILE, AL 36619
HUNTER, JESSE	Director	7700 FORSYTH BLVDST. LOUIS, MO 63105
WARREN, EDDIE	Director	714 NORTH THREE NOTCH STREETTROY, AL 36081
MAY, ZINA	Director	1765 WOODLAND HILLS COURTSEMMES, AL 36575

Name	Role	Address
ENSLEY, RICHARD	Incorporator	223 DRIFTWOOD LANETALLASSEE, AL 36078
CAMERIO, MICHAEL L	Incorporator	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
WHITNEY, TODD W	Incorporator	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117

Event Date	Event Type	Old Value	New Value
2014-09-22	Name Change	Alabama Healthcare Advantage South LLC	Alabama HealthCare Advantage South, Inc.

Date of last update: 03 Aug 2024

Sources: Alabama Secretary of State