| Name: | The Bethesda Life Center, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 14 Mar 2005 (20 years ago) |
| Entity Number: | 000-561-526 |
| Register Number: | 000561526 |
| County: | Etowah |
| Place of Formation: | Jefferson County |
| Principal Address: | 201 WALL STREETGADSDEN, A; 35904 |
| Principal Address ZIP Code: | 35904 |
| Registered Office Street Address: | 201 WALL STREETGADSDEN, AL 35904 |
| Registered Office Street Address ZIP Code: | 35904 |
Activities
ANY LAWFUL ACTIVITES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366565194 | 2007-04-08 | 2013-11-19 | PO BOX 8348, BIRMINGHAM, AL, 352180348, US | 321 19TH STREET ENSLEY, BIRMINGHAM, AL, 352181642, US | |||||||||||||||||||||||||
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| Phone | +1 205-788-2200 |
| Fax | 2057882201 |
Authorized person
| Name | MS. BETTINA BYRD-GILES |
| Role | COO |
| Phone | 2057882200 |
Taxonomy
| Taxonomy Code | 207QH0002X - Hospice and Palliative Medicine (Family Medicine) Physician |
| License Number | 1020764 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110037 |
| State | AL |
| Name | Role |
|---|---|
| EL-AMEXEM, AHMOSE | Agent |
| Name | Role |
|---|---|
| AMEXEM-EL, AHMOSE | Incorporator |
| Name | Role | Address |
|---|---|---|
| TARGET MANAGEMENT HOLDINGS | Director | 201 WALL STREETGADSDEN, AL 35904 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
