| Name: | Pleasant Grove Nursing and Rehabilitation Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 07 May 2003 (22 years ago) |
| Date of dissolution: | 06 Jan 2015 |
| Entity Number: | 000-689-938 |
| Register Number: | 000689938 |
| 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 | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033200068 | 2006-09-27 | 2020-08-22 | 30 7TH ST, PLEASANT GROVE, AL, 351271962, US | 30 7TH ST, PLEASANT GROVE, AL, 351271962, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 205-744-8226 |
| Fax | 2057448211 |
Authorized person
| Name | MR. NORBERT A BENNETT |
| Role | CO-CEO |
| Phone | 7166624955 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12574 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4757310S |
| State | AL |
| Issuer | BC BS OF ALAMBAMA |
| Number | 00385 |
| State | AL |
| Issuer | MEDICARE COMPLETE |
| Number | 71-00024 |
| 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
