| Name: | LifeSource of North Carolina, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Date of registration: | 05 Apr 2011 (14 years ago) |
| Entity Number: | 000-387-430 |
| Register Number: | 000387430 |
| County: | Madison |
| Place of Formation: | North Carolina |
| Principal Address: | 5617 MAXWELL PLACEWILMINGTON, NC 28409 |
| Principal Mailing Address: | 3205 RANDALL PARKWAY #105WILMINGTON, NC 28403 |
| Registered Office Street Address: | 505 OWENS DRIVE SEHUNTSVILLE, AL 35801 |
| Registered Office Street Address ZIP Code: | 35801 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821535428 | 2017-01-21 | 2021-03-26 | PO BOX 538622, ATLANTA, GA, 303538622, US | 1424 MONTCLAIR RD, IRONDALE, AL, 352102208, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 910-742-9243 |
Authorized person
| Name | PEGGY BADDOUR |
| Role | PRESIDENT/OWNER |
| Phone | 9107779165 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 363A00000X - Physician Assistant |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| URS AGENTS, LLC | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
