| Name: | Jubilee Pediatric Speech Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 07 Dec 2015 (9 years ago) |
| Date of dissolution: | 19 Feb 2019 |
| Entity Number: | 000-350-718 |
| Register Number: | 000350718 |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 9518 AUTAUGA BENDDAPHNE, AL 36526 |
| Registered Office Street Address ZIP Code: | 36526 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821463092 | 2015-12-14 | 2016-06-21 | 9086 MERRITT LN, SUITE D, DAPHNE, AL, 365265612, US | 9086 MERRITT LN, SUITE D, DAPHNE, AL, 365265612, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 251-340-2166 |
| Fax | 2514053416 |
Authorized person
| Name | LORI G FORAN |
| Role | OWNER |
| Phone | 2513402166 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | 2955 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1518101047 |
| State | GA |
| Name | Role |
|---|---|
| FORAN, LORI G | Agent |
| Name | Role |
|---|---|
| FORAN, LORI G | Organizer |
Date of last update: 03 Aug 2024
Sources: Alabama Secretary of State
