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Faith Medical Clinic LLC

Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role
HENDERSON, PAULA Agent

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State