| 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) |
| Entity Number: | 000-668-052 |
| Register Number: | 000668052 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 420 NORTH 20TH ST STE 3100BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
Activities
OPERATE/OWN SKILLED CARE NURSING FACILITIES
| 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 | |||||||||||||||||||||||||||||||||||||||||||||
|
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| 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 |
|---|
| 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 | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| 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 |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| NORTHPORT HOLDING LLC | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
