| Name: | King Certified Residential Facility, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 03 May 2005 (20 years ago) |
| Entity Number: | 000-464-019 |
| Register Number: | 000464019 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | NORTHPORT, AL |
| Registered Office Street Address: | 4008 FLATWOODS ROADNORTHPORT, AL 35473 |
| Registered Office Street Address ZIP Code: | 35473 |
Activities
PROVIDE HOUSING/PERSONAL CARE FOR DISABLED INDIVIDUALS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497910244 | 2008-07-22 | 2008-07-22 | 4008 FLATWOODS RD, NORTHPORT, AL, 354731101, US | 4008 FLATWOODS ROAD, NORTHPORT, AL, 354731101, US | |||||||||||||||||||
|
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| Phone | +1 205-792-7829 |
| Fax | 2053301359 |
Authorized person
| Name | RENEE KING HOLLEY |
| Role | FAMILY PROVIDER |
| Phone | 2057927829 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| License Number | 5324343 |
| State | AL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| KING-HOLLEY, RENEE | Agent |
| Name | Role |
|---|---|
| KING-HOLLEY, RENEE | Member |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
