| Name: | DHS of Blount County, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 26 Aug 1998 (26 years ago) |
| Entity Number: | 000-601-138 |
| Register Number: | 000601138 |
| County: | Blount |
| Place of Formation: | Tennessee |
| Principal Address: | 3839 FOREST HILL-IRENE ROADMEMPHIS, TN 38125 |
| Registered Office Street Address: | 204 WASHINGTON AVEONEONTA, AL 35121 |
| Registered Office Street Address ZIP Code: | 35121 |
Activities
ALL LAWFUL BUSINESS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134111081 | 2005-08-17 | 2022-07-21 | 212 ELLEN ST, P.O. BOX 698, ONEONTA, AL, 351212720, US | 212 ELLEN ST, ONEONTA, AL, 351212720, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-625-3520 |
| Fax | 2056253680 |
Authorized person
| Name | MRS. CAREN SUE JOHNSON |
| Role | ADMINISTRATOR |
| Phone | 2056253520 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10468 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| State | TN |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51521486 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4757940S |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 011251 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| LONG, BRADLEY D | Agent | 111 1ST AVENUE EASTONEONTA, AL 35121 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
