| Name: | AseraCare Hospice - Russellville, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 May 2004 (21 years ago) (Companies founded in May 2004) |
| Entity Number: | 000-606-751 |
| Register Number: | 000606751 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | ONE THOUSAND BEVERLY WAYFORT SMITH, AR 72919 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Activities
HOSPICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083651525 | 2006-06-01 | 2020-07-06 | 3854 AMERICAN WAY STE A, BATON ROUGE, LA, 708164897, US | 432 MOULTON ST E, DECATUR, AL, 356013002, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 225-292-2031 |
| Fax | 2252959678 |
| Phone | +1 330-760-2805 |
Authorized person
| Name | PAUL KUSSEROW |
| Role | PRESIDENT |
| Phone | 2252922031 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PIC1028E |
| State | AL |
| Issuer | BCBS |
| Number | 012-491 |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 7T7Q3 | Active | Non-Manufacturer | 2017-02-21 | 2021-11-13 | 2025-11-17 | 2021-11-13 | |||||||||||||||||||||
|
|||||||||||||||||||||||||||
| POC | KIM THEVENOT |
| Phone | +1 800-467-2662 |
| Address | 432 MOULTON ST E, DECATUR, AL, 35601 3002, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | |
|---|---|
| Vendor Certified | 2020-11-17 |
| CAGE number | 1ME56 |
| Company Name | AMEDISYS, INC. |
| CAGE Last Updated | 2024-07-01 |
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
