| Name: | Crowne Health Care of Fort Payne, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 Sep 2003 (21 years ago) |
| Entity Number: | 000-693-061 |
| Register Number: | 000693061 |
| County: | Monroe |
| Place of Formation: | DeKalb County |
| Registered Office Street Address: | 501 WHETSTONE STREETMONROEVILLE, AL 36460 |
| Registered Office Street Address ZIP Code: | 36460 |
Activities
OPERATE SKILLED CARE NURSING FACILITIES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508825076 | 2006-03-22 | 2024-03-06 | 501 WHETSTONE ST, MONROEVILLE, AL, 364602615, US | 403 13TH ST NW, FORT PAYNE, AL, 359673145, US | |||||||||||||||||||||||||||||
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| Phone | +1 251-743-3609 |
| Fax | 2515755618 |
| Phone | +1 256-845-5990 |
| Fax | 2568455992 |
Authorized person
| Name | NOEL DUNNAM |
| Role | CFO |
| Phone | 2517437137 |
Taxonomy
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| License Number | 12527 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4757520S |
| State | AL |
| Name | Role |
|---|---|
| DUNNAM, NOEL N NOEL N | Agent |
| Name | Role |
|---|---|
| CROWNE MANAGEMENT CORPORATION | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
