| Name: | Azalea Behavioral Health, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 23 Oct 2018 (6 years ago) (Companies founded in October 2018) |
| Entity Number: | 000-533-696 |
| Register Number: | 000533696 |
| ZIP code: | 36607 (Companies in Mobile, 36607) |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | 2854 OLD SHELL ROADMOBILE, AL 36607 |
| Registered Office Street Address: | 3929 AIRPORT BOULEVARD, SUITE 3-300MOBILE, AL 36609 |
| Authorized Capital: | 1,000 |
Activities
MEDICAL PRACRTICE SPECIALIZING IN PSYCHIATRY
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| QFV8GLML13W5 | 2021-03-26 | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36609, 2235, USA | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36609, 2235, USA | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| URL | https://azaleabehavioralhealth.com |
| Congressional District | 01 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2020-04-09 |
| Initial Registration Date | 2020-02-19 |
| Entity Start Date | 2018-10-23 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621112, 621330, 621420, 621498 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| Title | ALTERNATE POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| Title | ALTERNATE POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| Past Performance | |
|---|---|
| Title | PRIMARY POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| Title | ALTERNATE POC |
| Name | RENE LUMENE |
| Role | HEALTHCARE BUSINESS CONSULTANT |
| Address | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 36608, USA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063971091 | 2019-03-19 | 2019-05-31 | 4721 MORRISON DR STE 400, MOBILE, AL, 366093350, US | 3929 AIRPORT BLVD STE 3-300, MOBILE, AL, 366092235, US | |||||||||||||||||||||
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| Phone | +1 251-340-6947 |
| Fax | 2514605457 |
| Phone | +1 251-444-5868 |
Authorized person
| Name | DR. CANDES DOTSON |
| Role | PRESIDENT/OWNER/DOCTOR |
| Phone | 2514445868 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1861713703 |
| Name | Role | Address |
|---|---|---|
| DOTSON, CANDES L | Agent | 2854 OLD SHELL ROADMOBILE, AL 36607 |
| Name | Role | Address |
|---|---|---|
| DOTSON, CANDES L | Director | 2854 OLD SHELL ROADMOBILE, AL 36607 |
| Name | Role | Address |
|---|---|---|
| DOTSON, CANDES L | Incorporator | 2854 OLD SHELL ROADMOBILE, AL 36607 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
