| Name: | Arrowhead Dialysis, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Mar 2009 (16 years ago) (Companies founded in March 2009) |
| Entity Number: | 000-617-348 |
| Register Number: | 000617348 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 601 HAWAII STREETEL SEGUNDO, CA 90245 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Activities
KIDNEY DIALYSIS SERVICES
| Unique Entity ID | Expiration Date | Physical Address | Mailing Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EV8NPNQQ87V7 | 2022-12-29 | 1850 MCFARLAND BLVD N STE B, TUSCALOOSA, AL, 35406, 2138, USA | PO BOX 781168, PHILADELPHIA, PA, 19178, 1168, USA | |||||||||||||||||||||||||||||||||||||||
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| Doing Business As | NORTHRIVER HOME DIALYSIS (PD) |
| Congressional District | 04 |
| State/Country of Incorporation | AL, USA |
| Activation Date | 2021-12-06 |
| Initial Registration Date | 2020-09-29 |
| Entity Start Date | 2000-10-04 |
| Fiscal Year End Close Date | Dec 31 |
Service Classifications
| NAICS Codes | 621492 |
Points of Contacts
| Electronic Business | |
|---|---|
| Title | PRIMARY POC |
| Name | COURTNEY DUDLEY |
| Address | 32275 32ND AVE S, FEDERAL WAY, WA, 98001, USA |
| Government Business | |
|---|---|
| Title | PRIMARY POC |
| Name | COURTNEY DUDLEY |
| Address | 32275 32ND AVE S, FEDERAL WAY, WA, 98001, USA |
| Past Performance | Information not Available |
|---|
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245841550 | 2020-08-11 | 2022-07-06 | 5200 VIRGINIA WAY, L&C DEPARTMENT, BRENTWOOD, TN, 370277569, US | 1850 MCFARLAND BLVD N STE B, TUSCALOOSA, AL, 354062138, US | |||||||||||||||||||||||
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| Phone | +1 615-320-4268 |
| Fax | 8772380567 |
| Phone | +1 205-556-5541 |
Authorized person
| Name | JOHN D WINSTEL |
| Role | CHIEF ACCOUNTING OFFICER |
| Phone | 2537334501 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 262561 |
| State | AL |
| 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
