| Name: | Petersville Family Care, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 06 Apr 2018 (7 years ago) |
| Entity Number: | 000-515-176 |
| Register Number: | 000515176 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Registered Office Street Address: | 3502 CLOVERDALE ROADFLORENCE, AL 35633 |
| Registered Office Street Address ZIP Code: | 35633 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477040483 | 2018-04-16 | 2024-05-03 | 2929 CLOVERDALE RD UNIT D, FLORENCE, AL, 356331505, US | 2929 CLOVERDALE RD, FLORENCE, AL, 35633, US | |||||||||||||||||||||||||||
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| Phone | +1 256-275-7125 |
| Fax | 2562757254 |
| Phone | +1 256-366-3551 |
Authorized person
| Name | MRS. SUSAN DENISE MILLER |
| Role | OWNER |
| Phone | 2562757125 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | 1-01128 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1265837769 |
| State | AL |
| Name | Role |
|---|---|
| MILLER, SUSAN D | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
