| Name: | South Hampton Nursing & Rehabilitation Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 19 Feb 2002 (23 years ago) |
| Entity Number: | 000-680-442 |
| Register Number: | 000680442 |
| County: | Cherokee |
| Place of Formation: | Cherokee County |
| Principal Address: | 230 WEST MAIN STREETCENTRE, AL 35960 |
| Principal Address ZIP Code: | 35960 |
Activities
NURSING HOME/REHABILITATION FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598752073 | 2005-09-30 | 2015-05-13 | 213 WILSON MANN RD, OWENS CROSS ROADS, AL, 357638606, US | 213 WILSON MANN RD, OWENS CROSS ROADS, AL, 357638606, US | |||||||||||||||||||||||||
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| Phone | +1 256-725-3400 |
| Fax | 2567253423 |
Authorized person
| Name | MRS. MONTE S STICKLER |
| Role | REGIONAL ACCT. |
| Phone | 2566773819 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10596 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4758120S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WALKER, JAMES P JR | Agent | 230 WEST MAIN STREETCENTRE, AL 35960 |
| Name | Role | Address |
|---|---|---|
| WALKER, JAMES P JR | Member | 230 WEST MAIN STREETCENTRE, AL 35960 |
| Name | Role | Address |
|---|---|---|
| WALKER, JAMES P JR | Organizer | 230 WEST MAIN STREETCENTRE, AL 35960 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DO | AWARD | V674C85373 | 2004-08-18 | 2007-08-17 | 2009-08-17 | |||||||||||||||||||
|
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| Title | NURSING HOME |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOUTH HAMPTON NURSING & REHABILITATION CENTER, LLC |
| UEI | CK5QEJM831X5 |
| Legacy DUNS | 134513006 |
| Recipient Address | UNITED STATES, 213 WILSON MANN ROAD, OWENS CROSS ROADS, 357638606 |
| Unique Award Key | CONT_AWD_VA674C85204_3600_V247P1405_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Description
| Title | NURSING HOME |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SOUTH HAMPTON NURSING & REHABILITATION CENTER, LLC |
| UEI | CK5QEJM831X5 |
| Legacy DUNS | 134513006 |
| Recipient Address | UNITED STATES, 213 WILSON MANN ROAD, OWENS CROSS ROADS, 357638606 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
