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Crossville Health and Rehabilitation, L.L.C.

Details

Name: Crossville Health and Rehabilitation, L.L.C.
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 26 Jul 2004 (20 years ago) (Companies founded in July 2004)
Entity Number: 000-453-737
Register Number: 000453737
Historical Names: Crossville Health Realty, L.L.C.
ZIP code: 35203 (Companies in Jefferson, 35203)
County: Jefferson
Place of Formation: Jefferson County
Registered Office Street Address: 420 N 20TH ST STE 3100BIRMINGHAM, AL 35203

Activities ACQUIRE/OPERATE/OWN SKILLED CARE NURSING FACILITIES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1336200526 2006-12-12 2020-10-12 8922 HIGHWAY 227 NORTH, CROSSVILLE, AL, 35962, US 8922 HIGHWAY 227 NORTH, CROSSVILLE, AL, 35962, US

Contacts

Phone +1 256-528-7844

Authorized person

Name MR. PHILLIP CODY LONG
Role VICE-PRESIDENT
Phone 2053913600

Taxonomy

Taxonomy Code 314000000X - Skilled Nursing Facility
Is Primary Yes

Other Provider Identifiers

Issuer MEDICAID
Number 4754400S
State AL
Issuer BCBS ID
Number 014226
State AL

Agent

Name Role Address
CHRISTIAN, EDWARD R Agent 420 20TH ST N STE 3400BIRMINGHAM, AL 35203

Member

Name Role
NORTHPORT HOLDING LLC Member

Events

Event Date Event Type Old Value New Value
2006-12-15 Name Change Crossville Health Realty, L.L.C. Crossville Health and Rehabilitation, L.L.C.

Date of last update: 13 Aug 2024

Sources: Alabama Secretary of State