Name: | Faith Medical Clinic LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 31 Mar 2020 (5 years ago) (Companies founded in March 2020) |
Entity Number: | 000-627-355 |
Register Number: | 000627355 |
ZIP code: | 35967 (Companies in De Kalb, 35967) |
County: | De Kalb |
Place of Formation: | DeKalb County |
Registered Office Street Address: | 914 DRIVER LANE NWFORT PAYNE, AL 35967 |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1487274650 | 2020-04-17 | 2020-11-02 | 64 MCCURDY AVE N, RAINSVILLE, AL, 359864465, US | 64 MCCURDY AVE N, RAINSVILLE, AL, 359864465, US | |||||||||||||||||||||
|
Phone | +1 256-638-4411 |
Fax | 2566389275 |
Authorized person
Name | PAULA HENDERSON |
Role | NURSE PRACTITIONER |
Phone | 2566384411 |
Taxonomy
Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 1912470824 |
State | AL |
Name | Role |
---|---|
HENDERSON, PAULA | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State