| Name: | ProHealth LTC-Trussville, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Jun 2016 (8 years ago) (Companies founded in June 2016) |
| Entity Number: | 000-364-652 |
| Register Number: | 000364652 |
| ZIP code: | 35242 (Companies in Shelby, 35242) |
| County: | Shelby |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 1800 CORPORATE DRIVEBIRMINGHAM, AL 35242 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497117279 | 2016-03-22 | 2019-05-01 | 717 37TH ST S, BIRMINGHAM, AL, 352223244, US | 119 WATTERSON PKWY, TRUSSVILLE, AL, 351732307, US | |||||||||||||||||||||||||
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| Phone | +1 205-341-7300 |
| Fax | 8553019880 |
| Phone | +1 205-655-3226 |
| Fax | 2056612366 |
Authorized person
| Name | DAVID ALAN LESTER |
| Role | CEO |
| Phone | 2058207000 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 191841 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| LESTER, DAVID A | Agent | 717 37TH STREET SOUTHBIRMINGHAM, AL 35222 |
| Name | Role | Address |
|---|---|---|
| LESTER, DAVID A | Organizer | 717 37TH STREET SOUTHBIRMINGHAM, AL 35222 |
Date of last update: 04 Aug 2024
Sources: Alabama Secretary of State
