| Name: | Moundville Health and Rehabilitation, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 08 Nov 2002 (22 years ago) |
| Entity Number: | 000-686-003 |
| Register Number: | 000686003 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 420 N 20TH ST STE 3100BIRMINGHAM, AL 35203 |
| Registered Office Street Address ZIP Code: | 35203 |
Activities
OPERATE SKILLED CARE NURSING FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831139898 | 2006-06-07 | 2020-10-01 | 121 UNION ST, MOUNDVILLE, AL, 35474, US | 121 UNION ST, MOUNDVILLE, AL, 35474, US | |||||||||||||||||||||||||
|
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| Phone | +1 205-371-2252 |
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 | 012709 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4754560S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CHRISTIAN, EDWARD R | Agent | 420 20TH ST N STE 3400BIRMINGHAM, AL 35203 |
| Name | Role |
|---|---|
| NHS OPERATIONS LLC | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
