| Name: | Tennessee Valley Healthcare, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 25 Jun 2003 (21 years ago) |
| Entity Number: | 000-691-239 |
| Register Number: | 000691239 |
| County: | Limestone |
| Place of Formation: | Limestone County |
| Principal Address: | ATHENS, AL |
| Registered Office Street Address: | 200 W MARKET STATHENS, AL 35611 |
| Registered Office Street Address ZIP Code: | 35611 |
Activities
OPERATE A DRUG STORE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477568087 | 2006-07-30 | 2018-07-19 | PO BOX 709, ATHENS, AL, 356120709, US | 200 W MARKET ST, ATHENS, AL, 356112555, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 256-232-3811 |
| Fax | 2562322422 |
Authorized person
| Name | HEATH CHITTAM |
| Role | PIC |
| Phone | 2502323811 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | 112319 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100003506 |
| State | AL |
| Issuer | PK |
| Number | 1987941 |
| Name | Role | Address |
|---|---|---|
| CAMPBELL, JOSH | Member | 162 SOUTHERN OAK LANEWETUMPKA, AL 36093 |
| WILLINGHAM, CHANDLER T | Member | 8751 Blue Springs DriveAthens, AL 35611 |
| POWERS, MICHAEL | Member | 104 Clear Springs CirHazel Green, AL 35611 |
| Name | Role | Address |
|---|---|---|
| WILLINGHAM, CHANDLER T | Agent | 8751 Blue Springs DriveAthens, AL 35611 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
