Alabama Healthcare Advantage West

Details

Name:	Alabama Healthcare Advantage West
Jurisdiction:	Alabama
Legal type:	Domestic Non-Profit Corporation
Status:	Dissolved
Date of registration:	16 Oct 2014 (10 years ago) (Companies founded in October 2014)
Date of dissolution:	21 Apr 2017
Entity Number:	000-320-770
Register Number:	000320770
ZIP code:	36117 (Companies in Montgomery, 36117)
County:	Montgomery
Place of Formation:	Montgomery County
Principal Address:	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
Registered Office Street Address:	2740 ZELDA ROADMONTGOMERY, AL 36106

Activities TO BECOME A MEDICAID RCO IN REGION

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1225493943

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
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
WARREN, EDDIE	Director	714 NORTH THREE NOTCH STREETTROY, AL 36081
HOWARD, RON	Director	312 JAMES STREETTALLASSEE, AL 36078
NORMAN, JIMMY	Director	305 PAUL W BRYANT DRIVETUSCALOOSA, AL 35401
FULGHAM, PRESTON SCOTT	Director	1515 UNIVERSITY BOULEVARD SOUTHMOBILE, AL 36609
WALTON, GARY	Director	514 MESOPOTAMIA STREETEUTAW, AL 35462
ARNOLD, SCOTT	Director	850 5TH AVENUE EASTTUSCALOOSA, AL 35401
REDDY, RAMESH	Director	911 21ST STHALEYVILLE, AL 35565
GREEN, CHAD	Director	1401 US HIGHWAY 80 WESTDEMOPOLIS, AL 36732
COLBURN, ROB	Director	4942 GLEN EAGLE DRIVETUSCALOOSA, AL 35406
BRASHER, TANYA	Director	1256 MILITARY STREET SOUTHHAMILTON, AL 35570
BROWN, MARTY	Director	1310 FOREST BROOK DRIVEDEMPOLIS, AL 36732
KING, LISA	Director	166 CR 40EUFAULA, AL 36027
PATCHEN, JASON	Director	3505 E FRONTAGE ROAD, STE 250TAMPA, FL 33607
HUNTER, JESSE	Director	7700 FORSYTH BLVDST. LOUIS, MO 63105
WHITNEY, TODD W	Director	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
RAHN, ED	Director	1102 A1A NORTH SUITE 202PONTE VEDRA BEACH, FL 32802

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

Date of last update: 03 Aug 2024