| Name: | NRA-Roanoke, Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 16 Aug 2002 (22 years ago) |
| Entity Number: | 000-604-467 |
| Register Number: | 000604467 |
| County: | Montgomery |
| Place of Formation: | Tennessee |
| Registered Office Street Address: | 2000 INTERSTATE PARK DR STE 2O4NONTGOMERY, AL 36109 |
| Registered Office Street Address ZIP Code: | 36109 |
| Principal Address: | 420 ELMINGTON AVE NO 802NASHVILLE, TN 37205 |
Activities
RENAL DIALYSIS CLINICS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861483281 | 2005-11-03 | 2023-10-17 | 4459 HIGHWAY 431, ROANOKE, AL, 362742603, US | 4459 HIGHWAY 431, ROANOKE, AL, 362742603, US | |||||||||||||||||||||||||||||||
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| Phone | +1 334-863-8365 |
| Fax | 3348638364 |
Authorized person
| Name | BARRY L. BLANTON |
| Role | VICE PRESIDENT |
| Phone | 7816999000 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| License Number | 10801 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA |
| Number | 01D1007307 |
| State | AL |
| Issuer | MEDICAID |
| Number | DIA2607D |
| State | AL |
| Name | Role | Address |
|---|---|---|
| THE CORPORATION COMPANY | Agent | 2000 INTERSTATE PARK DR STE 204MONTGOMERY, AL 36109 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
