| Name: | Diversicare of Pell City, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 01 Jul 2016 (8 years ago) (Companies founded in July 2016) |
| Entity Number: | 000-369-303 |
| Register Number: | 000369303 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 1621 Galleria BoulevardBrentwood, TN 37027 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1942755038 | 2016-08-18 | 2023-04-07 | 1621 GALLERIA BLVD, BRENTWOOD, TN, 370272926, US | 510 WOLF CREEK RD N, PELL CITY, AL, 351252477, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 615-550-9453 |
| Fax | 6159156935 |
| Phone | +1 205-338-3329 |
| Fax | 2053381006 |
Authorized person
| Name | MATTHEW J WEISHAAR |
| Role | CHIEF FINANCIAL OFFICER |
| Phone | 6155509459 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 5804 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 199986 |
| 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
