| Name: | Dadeville Healthcare Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 18 Nov 2003 (21 years ago) |
| Entity Number: | 000-695-001 |
| Register Number: | 000695001 |
| County: | Tallapoosa |
| Place of Formation: | Tallapoosa County |
| Principal Address: | DADEVILLE, AL |
| Registered Office Street Address: | 314 WEST COLUMBUS STREETDADEVILLE, AL 36853 |
| Registered Office Street Address ZIP Code: | 36853 |
Activities
OPERATE A SKILLED NURSING FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346279114 | 2006-07-02 | 2022-02-01 | PO BOX 97, DADEVILLE, AL, 368530097, US | 351 N EAST ST, DADEVILLE, AL, 368531517, US | |||||||||||||||||||||||||||||||
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| Phone | +1 256-825-9244 |
| Fax | 2568259964 |
Authorized person
| Name | VICKY STEPHENSON |
| Role | ADMISSIONS BOOKKEEPER |
| Phone | 2568259244 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12685 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4756000S |
| State | AL |
| Issuer | MEDICAID |
| Number | 47560005 |
| State | AL |
| Name | Role |
|---|---|
| CHAPMAN, ARCHIE J | Agent |
| Name | Role |
|---|---|
| PRIME HEALTH CARE ENTERPRISES INC | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
