| Name: | Legacy Health and Rehabilitation of Pleasant Grove, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 May 2007 (17 years ago) |
| Entity Number: | 000-495-298 |
| Register Number: | 000495298 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Registered Office Street Address: | 420 N 20TH ST STE 3400BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
| Principal Address: | BIRMINGHAM, AL |
Activities
OPERATE SKILLED CARE NURSING FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770781114 | 2007-07-06 | 2020-10-28 | 30 7TH ST, PLEASANT GROVE, AL, 351271962, US | 30 7TH ST, PLEASANT GROVE, AL, 351271962, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-744-8226 |
Authorized person
| Name | PHILLIP CODY LONG |
| Role | VICE-PRESIDENT |
| Phone | 2053913600 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | N3748 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 013348 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4758210S |
| 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: 14 Aug 2024
Sources: Alabama Secretary of State
