Name: | Wiregrass Behavioral Group, LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 08 Mar 2018 (7 years ago) |
Entity Number: | 000-511-845 |
Register Number: | 000511845 |
County: | Houston |
Place of Formation: | Houston County |
Registered Office Street Address: | 105 RICHBERRY DRIVEDOTHAN, AL 36301 |
Registered Office Street Address ZIP Code: | 36301 |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1821609389 | 2020-08-10 | 2020-08-13 | 256 HONEYSUCKLE RD STE 12, DOTHAN, AL, 363051168, US | 256 HONEYSUCKLE RD STE 12, DOTHAN, AL, 363051168, US | |||||||||||||||
|
Phone | +1 334-792-6736 |
Fax | 3347926737 |
Authorized person
Name | MISS PHILLIP JOHNSON |
Role | PRESIDENT |
Phone | 3347926736 |
Taxonomy
Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
JOHNSON, PHILLIP | Agent | 105 RICHBERRY DRIVEDOTHAN, AL 36301 |
Name | Role | Address |
---|---|---|
JOHNSON, PHILLIP | Organizer | 105 RICHBERRY DRIVEDOTHAN, AL 36301 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State