| Name: | Fairfield Nursing and Rehabilitation Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 07 May 2003 (22 years ago) |
| Entity Number: | 000-689-935 |
| Register Number: | 000689935 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Mailing Address: | 444 S PERRY STMONTGOMERY, AL 36104-0347 |
| Registered Office Street Address: | 444 S PERRY STMONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
Activities
OPERATE/MANAGE HEALTH CARE FACILITIES/SKILLED NURSING SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053484261 | 2006-11-16 | 2023-12-11 | PO BOX 428, ORCHARD PARK, NY, 141270428, US | 6825 GRASSELLI RD, FAIRFIELD, AL, 350641727, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 716-662-4955 |
| Fax | 7166679230 |
| Phone | +1 205-780-3920 |
| Fax | 2057800623 |
Authorized person
| Name | MR. NORBERT A BENNETT |
| Role | CO-CHIEF EXECUTIVE OFFICER |
| Phone | 7166624955 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12563 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE COMPLETE |
| Number | 71-00011 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4757360S |
| State | AL |
| Issuer | BC BS OF ALABAMA |
| Number | 00386 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| GILL, RICHARD H | Agent | 444 SOUTH PERRY STREETMONTGOMERY, AL 36101 |
| Name | Role |
|---|---|
| LKC LLC | Member |
| D & N LLC | Member |
| DTD HC LLC | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
