| Name: | Go Play Therapy, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 23 Jan 2018 (7 years ago) |
| Entity Number: | 000-507-918 |
| Register Number: | 000507918 |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 804 GREENHILL BLVD SUITE 102FORT PAYNE, AL 35967 |
| Registered Office Street Address ZIP Code: | 35967 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912406927 | 2018-02-05 | 2018-11-27 | 2804 GREENHILL BLVD NW STE 102, FORT PAYNE, AL, 359683067, US | 2804 GREENHILL BLVD NW STE 102, FORT PAYNE, AL, 359683067, US | |||||||||||||||||||||
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| Phone | +1 256-979-1222 |
| Fax | 2569791223 |
Authorized person
| Name | MS. SILVIA HERNANDEZ |
| Role | OWNER / MANAGER |
| Phone | 2569791222 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 212348 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, SILVIA | Agent | 804 GREENHILL BLVD SUITE 102FORT PAYNE, AL 35967 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, SILVIA | Organizer | 804 GREENHILL BLVD SUITE 102FORT PAYNE, AL 35967 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
