| Name: | South Haven Health and Rehabilitation, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Nov 2004 (20 years ago) |
| Entity Number: | 000-457-438 |
| Register Number: | 000457438 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 420 N 20TH ST STE 3100BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
Activities
OPERATE SKILLED CARE NURSING FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083661821 | 2006-05-27 | 2020-10-28 | 3141 OLD COLUMBIANA RD, HOOVER, AL, 352263703, US | 3141 OLD COLUMBIANA RD, HOOVER, AL, 352263703, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 205-822-1580 |
Authorized person
| Name | PHILLIP CODY LONG |
| Role | CFO |
| Phone | 2053913600 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS ID |
| Number | 012650 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4753210S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| NORTHPORT HOLDING OPERATIONS LLC | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
