| 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) |
| Entity Number: | 000-453-737 |
| Register Number: | 000453737 |
| Historical Names: |
Crossville Health Realty, L.L.C.
|
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 420 N 20TH ST STE 3100BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
Activities
ACQUIRE/OPERATE/OWN SKILLED CARE NURSING FACILITIES
| 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 | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| 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 |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| NORTHPORT HOLDING LLC | Member |
| 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
