| Name: | Eclectic Family Care, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 21 Jul 2000 (24 years ago) (Companies founded in July 2000) |
| Entity Number: | 000-671-008 |
| Register Number: | 000671008 |
| ZIP code: | 36024 (Companies in Elmore, 36024) |
| County: | Elmore |
| Place of Formation: | Elmore County |
| Principal Address: | ECLECTIC, AL |
| Registered Office Street Address: | 575 CLAUDE RDECLECTIC, AL 36024 |
Activities
OWN/OPERATE A MEDICAL PRACTICE IN ECLECTIC AL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376613869 | 2006-11-09 | 2020-08-22 | PO BOX 241120, ECLECTIC, AL, 360240018, US | 575 CLAUD RD, ECLECTIC, AL, 360246318, US | |||||||||||||||||||||||||
|
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| Phone | +1 334-541-3020 |
| Fax | 3345413109 |
Authorized person
| Name | DR. GARY LEE MCCULLOCH SR. |
| Role | OWNER |
| Phone | 3345413020 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 12809 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 99530 |
| State | AL |
| Name | Role |
|---|---|
| MCCULLOCH, GARY L | Agent |
| Name | Role |
|---|---|
| MCCULLOCH, GARY L | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
