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Jacksonville Health and Rehabilitation, L.L.C.

Details

Name: Jacksonville Health and Rehabilitation, L.L.C.
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 12 Jan 2000 (25 years ago) (Companies founded in January 2000)
Entity Number: 000-668-052
Register Number: 000668052
ZIP code: 35203 (Companies in Jefferson, 35203)
County: Jefferson
Place of Formation: Jefferson County
Principal Address: BIRMINGHAM, AL
Registered Office Street Address: 420 NORTH 20TH ST STE 3100BIRMINGHAM, AL 35203

Activities OPERATE/OWN SKILLED CARE NURSING FACILITIES

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
UBZZF53JM3K7 2024-07-31 410 WILSON DR SW, JACKSONVILLE, AL, 36265, 2754, USA 410 WILSON DR SW, JACKSONVILLE, AL, 36265, USA

Business Information

Division Name JACKSONVILLE HEALTH AND REHABILITATION, LLC
Division Number 43
Congressional District 03
State/Country of Incorporation AL, USA
Activation Date 2023-08-09
Initial Registration Date 2016-04-06
Entity Start Date 2000-01-12
Fiscal Year End Close Date Dec 16

Service Classifications

NAICS Codes 623110

Points of Contacts

Electronic Business
Title PRIMARY POC
Name CASEY KNEPP
Role FINANCIAL SPECIALIST
Address 410 WILSON DRIVE SW, JACKSONVILLE, AL, 36265, USA
Government Business
Title PRIMARY POC
Name CRAIG HILL
Role ADMINISTRATOR
Address 410 WILSON DRIVE SW, JACKSONVILLE, AL, 36265, USA
Past Performance Information not Available

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1033166640 2006-05-28 2020-10-12 410 WILSON DR SW, JACKSONVILLE, AL, 362652754, US 410 WILSON DR SW, JACKSONVILLE, AL, 362652754, US

Contacts

Phone +1 256-435-7704

Authorized person

Name PHILLIP CODY LONG
Role CFO
Phone 2053913600

Taxonomy

Taxonomy Code 314000000X - Skilled Nursing Facility
Is Primary Yes

Other Provider Identifiers

Issuer BCBS ID
Number 012231
State AL
Issuer MEDICAID
Number 4757820S
State AL

Agent

Name Role Address
CHRISTIAN, EDWARD R Agent 420 20TH ST N STE 3400BIRMINGHAM, AL 35203

Member

Name Role
NORTHPORT HOLDING LLC Member

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State