| Name: | New Horizons Wellness Center, L.L.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 13 Feb 2004 (21 years ago) (Companies founded in February 2004) |
| Entity Number: | 000-697-332 |
| Register Number: | 000697332 |
| ZIP code: | 36330 (Companies in Coffee, 36330) |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Principal Address: | ENTERPRISE, AL |
| Registered Office Street Address: | 300 N EDWARDSENTERPRISE, AL 36330 |
Activities
ANY LAWFUL ACTIVITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184621120 | 2005-07-06 | 2018-03-27 | 300 N EDWARDS ST, ENTERPRISE, AL, 363302508, US | 1018 RUCKER BLVD STE A, ENTERPRISE, AL, 363303688, US | |||||||||||||||||||||||||
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| Phone | +1 334-347-4343 |
| Fax | 3343939611 |
Authorized person
| Name | DR. MARK B ELLIS |
| Role | PHYSICIAN |
| Phone | 3343474343 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | DO463 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529918990 |
| State | AL |
| Name | Role |
|---|---|
| ELLIS, MARK | Agent |
| Name | Role |
|---|---|
| ELLIS, MARK B | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
