| Name: | Park Place Nursing and Rehabilitation Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 21 Nov 2003 (21 years ago) |
| Date of dissolution: | 11 Jan 2021 |
| Entity Number: | 000-695-209 |
| Register Number: | 000695209 |
| County: | Elmore |
| Place of Formation: | Elmore County |
| Principal Address: | WETUMPKA, AL |
| Registered Office Street Address: | 200 SUGARBERRY HILLWETUMPKA, AL 36092 |
| Registered Office Street Address ZIP Code: | 36092 |
Activities
OPERATE A NURSING/REHABILITATION CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811005846 | 2006-08-29 | 2009-02-10 | 100 PARK PL, SELMA, AL, 367017743, US | 100 PARK PL, SELMA, AL, 367017743, US | |||||||||||||||||||||||||
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| Phone | +1 334-872-3471 |
| Fax | 3348728923 |
Authorized person
| Name | MR. CHARLES W. HISE |
| Role | ADMINISTRATOR |
| Phone | 3348723471 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12523 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4750840S |
| State | AL |
| Name | Role |
|---|---|
| WOOD, FRED K | Member |
| HISE, CHARLES W | Member |
| Name | Role |
|---|---|
| WOOD, FRED K | Agent |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
