| Name: | Allen Memorial Home |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 16 Jan 1973 (52 years ago) |
| Entity Number: | 000-705-062 |
| Register Number: | 000705062 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Registered Office Street Address: | 400 GOVERNMENT STREETMOBILE, AL 36602 |
| Registered Office Street Address ZIP Code: | 36602 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750367538 | 2005-12-22 | 2013-09-02 | 735 S WASHINGTON AVE, MOBILE, AL, 366031301, US | 735 S WASHINGTON AVE, MOBILE, AL, 366031301, US | |||||||||||||||||||||||||||||||
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| Phone | +1 251-433-2642 |
| Fax | 2514335502 |
Authorized person
| Name | CHERYL A ROBINSON |
| Role | ADMINISTRATOR |
| Phone | 2514332642 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 10608 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4750980S |
| State | AL |
| Issuer | STATE OF ALABAMA |
| Number | 10608 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| FARMER, MICHAEL L | Agent | 400 GOVERNMENT STREETMOBILE, AL 36602 |
| Name | Role | Address |
|---|---|---|
| KING, MARILYN | Director | 400 GOVERNMENT STREETMOBILE, AL 36602 |
| FARMER, MICHAEL L | Director | 400 GOVERNMENT STREETMOBILE, AL 36602 |
| MANRY, MICHELE C | Director | 400 GOVERNMENT STREETMOBILE, AL 36602-4727 |
| TOKARZ, DAVID | Director | 400 GOVERNMENT STREETMOBILE, AL 36602 |
| Name | Role |
|---|---|
| SULLIVAN, DAVID | Incorporator |
| MAY, MOST REV JOHN L | Incorporator |
| LIPSCOMB, REV OSCAR H | Incorporator |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
