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South Hampton Nursing & Rehabilitation Center, LLC

Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
WALKER, JAMES P JR Agent 230 WEST MAIN STREETCENTRE, AL 35960

Member

Name Role Address
WALKER, JAMES P JR Member 230 WEST MAIN STREETCENTRE, AL 35960

Organizer

Name Role Address
WALKER, JAMES P JR Organizer 230 WEST MAIN STREETCENTRE, AL 35960

Awards

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
Unique Award Key CONT_AWD_V674C85373_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
DO AWARD VA674C85204 2004-08-18 2007-08-17 2009-08-17
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