| Name: | Knollwood Healthcare, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 15 Nov 2007 (17 years ago) (Companies founded in November 2007) |
| Entity Number: | 000-614-445 |
| Register Number: | 000614445 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Georgia |
| Principal Address: | 1145 HEMBREE RDROSWELL, GA 30076 |
| Registered Office Street Address: | 150 SOUTH PERRY STREETMONTGOMERY, AL 36104 |
Activities
MEDICAL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770769119 | 2008-01-16 | 2008-02-27 | 3151 KNOLLWOOD DR # A, MOBILE, AL, 366932753, US | 3151 KNOLLWOOD DR # A, MOBILE, AL, 366932753, US | |||||||||||||||||||||||
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| Phone | +1 251-661-7608 |
Authorized person
| Name | TYGH BROGDON |
| Role | MANAGER |
| Phone | 7706508773 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | N4926 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 47579902 |
| State | AL |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES INC | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
