| Name: | Faith Medical Clinic LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 31 Mar 2020 (5 years ago) |
| Entity Number: | 000-627-355 |
| Register Number: | 000627355 |
| County: | De Kalb |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 914 DRIVER LANE NWFORT PAYNE, AL 35967 |
| Registered Office Street Address ZIP Code: | 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 | |||||||||||||||||||||
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| 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
