| Name: | Monroe Manor Nursing Home, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 14 May 2003 (22 years ago) |
| Entity Number: | 000-690-153 |
| Register Number: | 000690153 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | ONE SOUTHERN WAYMOBILE, AL 36619 |
| Registered Office Street Address ZIP Code: | 36619 |
Activities
ACQUIRE/OWN/INVEST IN/OPERATE/MANAGE A NURSING HOME
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013941764 | 2006-07-10 | 2016-03-31 | 1 SOUTHERN WAY, MOBILE, AL, 366191210, US | 236 W CLAIBORNE ST, MONROEVILLE, AL, 364601704, US | |||||||||||||||||||||||||||||
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| Phone | +1 251-433-9801 |
| Fax | 2514339807 |
| Phone | +1 251-575-2648 |
| Fax | 2515752647 |
Authorized person
| Name | MR. ZED D PERRIGIN |
| Role | ADMINISTRATOR |
| Phone | 2515752648 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12646 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4757130S |
| State | AL |
| Name | Role | Address |
|---|---|---|
| BALL, CLARENCE M JR | Agent | ONE SOUTHERN WAYMOBILE, AL 36619 |
| Name | Role | Address |
|---|---|---|
| BALL, CLARENCE M JR | Member | ONE SOUTHERN WAYMOBILE, AL 36619 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
