| Name: | Diversicare of Boaz, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Jul 2016 (8 years ago) |
| Entity Number: | 000-369-278 |
| Register Number: | 000369278 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 1621 Galleria BoulevardBrentwood, TN 37027 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396290466 | 2016-08-18 | 2023-04-07 | 1621 GALLERIA BLVD, BRENTWOOD, TN, 370272926, US | 600 CORLEY AVE, BOAZ, AL, 359575952, US | |||||||||||||||||||||||||||
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| Phone | +1 615-550-9453 |
| Fax | 6159156935 |
| Phone | +1 256-593-8380 |
| Fax | 2565933458 |
Authorized person
| Name | MATTHEW J WEISHAAR |
| Role | CHIEF FINANCIAL OFFICER |
| Phone | 6157717575 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 199941 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
