| Name: | Park Place Psychiatry, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 28 Dec 2000 (24 years ago) (Companies founded in December 2000) |
| Date of dissolution: | 18 Dec 2023 |
| Entity Number: | 000-673-434 |
| Register Number: | 000673434 |
| ZIP code: | 36117 (Companies in Montgomery, 36117) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 7051 FAIN PARK DR STE 117MONTGOMERY, AL 36117 |
Activities
PHYSICIANS WHO DELIVER PSYCHIATRIC/PSYCHOLOGICAL SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629108261 | 2007-03-06 | 2013-06-14 | P.O. BOX 241486, MONTGOMERY, AL, 361241486, US | 207 WINTON M. BLOUNT LOOP, MONTGOMERY, AL, 36117, US | |||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-356-1417 |
| Fax | 3343561433 |
Authorized person
| Name | MR. DAVID D. SCHAFTER |
| Role | OWNER |
| Phone | 3343561417 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | 2914 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| License Number | 1452 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| License Number | 2914 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | D0421 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529906980 |
| State | AL |
| Name | Role |
|---|---|
| SCHAFFER, DAVID D | Agent |
| Name | Role |
|---|---|
| SCHAFFER, DAVID D | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
