| Name: | Northgate Services of Missouri, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Merged |
| Date of registration: | 04 Dec 1997 (27 years ago) |
| Entity Number: | 000-601-684 |
| Register Number: | 000601684 |
| County: | Tuscaloosa |
| Place of Formation: | Missouri |
| Principal Address: | 931 FAIRFAX PARKTUSCALOOSA,, AL 35406 |
| Principal Address ZIP Code: | 35406 |
Activities
PROVIDE PHARMACEUTICAL PRODUCTS/MEDICAL EQPMNTS TO NURSING HOMES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407886732 | 2006-07-03 | 2010-10-11 | 961 FAIRFAX PARK, TUSCALOOSA, AL, 354062805, US | 961 FAIRFAX PARK, TUSCALOOSA, AL, 354062805, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 205-345-8858 |
| Fax | 2053457991 |
Authorized person
| Name | CLAUDE E LEE |
| Role | VICE PRESIDENT CFO |
| Phone | 2053913600 |
Taxonomy
| Taxonomy Code | 332BN1400X - Nursing Facility Supplies (DME) |
| License Number | 630016343 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009926990 |
| State | AL |
| Issuer | MEDICAID |
| Number | 141656741 |
| State | AR |
| Name | Role |
|---|---|
| BENTON, KEITH | Agent |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
