Name: | Florence Nursing and Rehabilitation Center, LLC |
Jurisdiction: | Alabama |
Legal type: | Domestic Limited Liability Company |
Status: | Exists |
Date of registration: | 07 May 2003 (22 years ago) (Companies founded in May 2003) |
Entity Number: | 000-689-936 |
Register Number: | 000689936 |
ZIP code: | 36104 (Companies in Montgomery, 36104) |
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 |
Activities
OPERATE/MANAGE HEALTH CARE FACILITIES/SKILLED NURSING SERVICES
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1972676104 | 2006-11-16 | 2023-12-08 | PO BOX 428, ORCHARD PARK, NY, 141270428, US | 2107 CLOYD BLVD, FLORENCE, AL, 356301503, US | |||||||||||||||||||||||||||||||||||||||||
|
Phone | +1 716-662-4955 |
Fax | 7166679230 |
Phone | +1 256-766-5771 |
Fax | 2567668135 |
Authorized person
Name | MR. NORBERT A BENNETT |
Role | CO-CHIEF EXECUTIVE OFFICER |
Phone | 7166624955 |
Taxonomy
Taxonomy Code | 314000000X - Skilled Nursing Facility |
License Number | 12593 |
State | AL |
Is Primary | Yes |
Other Provider Identifiers
Issuer | BC BS OF ALABAMA |
Number | 00387 |
State | AL |
Issuer | MEDICARE COMPLETE |
Number | 71-00015 |
State | AL |
Issuer | MEDICAID |
Number | 4757540S |
State | AL |
Name | Role |
---|---|
LKC LLC | Member |
D & N LLC | Member |
DTD HC LLC | Member |
Name | Role | Address |
---|---|---|
GILL, RICHARD H | Agent | 444 SOUTH PERRY STREETMONTGOMERY, AL 36101 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State