| Name: | Coosa Nursing ADK, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 10 Feb 2010 (15 years ago) |
| Entity Number: | 000-619-264 |
| Register Number: | 000619264 |
| County: | Etowah |
| Place of Formation: | Georgia |
| Principal Address: | 513 PINE VIEW AVENUEGLENCOE, AL 35905 |
| Principal Address ZIP Code: | 35905 |
| Registered Office Street Address: | 2 NORTH JACKSON ST STE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
NURSING HOME
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861586737 | 2006-10-03 | 2011-02-03 | 513 PINEVIEW AVE, GLENCOE, AL, 359051803, US | 513 PINEVIEW AVE, GLENCOE, AL, 359051803, US | |||||||||||||||||||||||
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| Phone | +1 256-492-5350 |
Authorized person
| Name | CAROL GROEBER |
| Role | VICE PRESIDENT/MIS |
| Phone | 9379648974 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12535 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4753160S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 6190 POWERS FERRY RD STE 600ATLANTA, GA 30339 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
