| Name: | Cantwell Family Psychiatry, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Series Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 31 Mar 2017 (8 years ago) |
| Date of dissolution: | 23 Oct 2023 |
| Entity Number: | 000-388-061 |
| Register Number: | 000388061 |
| Historical Names: |
Cantwell Family Psychiatry, LLC
Cantwell Family Psychiatry, PC |
| County: | Baldwin |
| Place of Formation: | Baldwin County |
| Principal Address: | 700 MIDDLE STREETFAIRHOPE, AL 36532 |
| Principal Address ZIP Code: | 36532 |
| Principal Mailing Address: | PO BOX 392FAIRHOPE, AL 36533 |
| Principal Mailing Address ZIP Code: | 36533 |
Activities
PROVIDE PSYCHIATRIC SERVICES FOR PATIENTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033649298 | 2017-06-19 | 2018-01-10 | PO BOX 392, FAIRHOPE, AL, 365330392, US | 770 MIDDLE ST, FAIRHOPE, AL, 365321766, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 251-517-5800 |
| Fax | 2515175801 |
Authorized person
| Name | DR. JOHN JOSEPH BRODERICK-CANTWELL |
| Role | OWNER |
| Phone | 2515175800 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | 28950 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | 28950 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CANTWELL, JOHN B | Agent | 700 MIDDLE STREETFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| CANTWELL, JOHN BRODERICK | Director | 356 N BAYVIEW STFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| CANTWELL, JOHN B | Incorporator | 700 MIDDLE STREETFAIRHOPE, AL 36532 |
| Name | Role | Address |
|---|---|---|
| CANTWELL, JOHN B | Organizer | 700 MIDDLE STREETFAIRHOPE, AL 36532 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2023-01-06 | Name Change | Cantwell Family Psychiatry, PC | Cantwell Family Psychiatry, LLC |
| 2017-07-17 | Name Change | Cantwell Family Psychiatry, LLC | Cantwell Family Psychiatry, PC |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
