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Bayou La Batre Area Health Development Board, Inc.

Details

Name: Bayou La Batre Area Health Development Board, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 18 Oct 1978 (46 years ago)
Entity Number: 000-713-587
Register Number: 000713587
Place of Formation: Mobile County
Principal Address: BAYOU LA BATRE, AL

Activities HEALTH CARE PROGRAM

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
X3DFXKD9J3B9 2024-12-25 12701 PADGETT SWITCH RD, IRVINGTON, AL, 36544, 4011, USA 12701 PADGETT SWITCH RD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA

Business Information
URL www.mostellarmedical.org
Congressional District 01
State/Country of Incorporation AL, USA
Activation Date 2023-12-28
Initial Registration Date 2006-07-11
Entity Start Date 1978-02-02
Fiscal Year End Close Date Nov 30

Points of Contacts
Electronic Business
Title PRIMARY POC
Name TODD STORK
Role COO
Address 12701 PADGETT SWITCH ROAD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA
Title ALTERNATE POC
Name JAMES HOLLAND
Address 12701 PADGETT SWITCH ROAD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA
Government Business
Title PRIMARY POC
Name TODD STORK
Role COO
Address 12701 PADGETT SWITCH ROAD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA
Title ALTERNATE POC
Name JAMES HOLLAND
Address 12701 PADGETT SWITCH ROAD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA
Past Performance
Title ALTERNATE POC
Name JAMES HOLLAND
Address 12701 PADGETT SWITCH ROAD, P. O. BOX 769, BAYOU LA BATRE, AL, 36509, USA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1811183882 2007-09-24 2007-09-24 PO BOX 769, BAYOU LA BATRE, AL, 365090769, US 12701 PADGETT SWITCH RD, IRVINGTON, AL, 365444011, US

Contacts
Phone +1 251-824-2174
Fax 2518243444

Authorized person
Name MR. JAMES A. HOLLAND
Role CHIEF EXECUTIVE OFFICER
Phone 2518242174

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
License Number N/A
State AL
Is Primary Yes

Commercial and government entity program

CAGE number Status Type Established CAGE Update Date CAGE Expiration SAM Expiration
4GDK0 Obsolete Non-Manufacturer 2006-07-11 2023-12-28 No data 2024-12-25

Contact Information
POC TODD STORK
Phone +1 251-824-2174
Fax +1 251-824-9654
Address 12701 PADGETT SWITCH RD, IRVINGTON, AL, 36544 4011, UNITED STATES

Ownership of Offeror Information
Highest Level Owner Information not Available
Immediate Level Owner Information not Available
List of Offerors (0) Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2021 630756832 2022-05-06 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 117
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2022-05-06
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2020 630756832 2021-06-09 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 114
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2021-06-09
Name of individual signing JAMES HOLLAND
Role Employer/plan sponsor
Date 2021-06-09
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2019 630756832 2020-05-11 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 108
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2020-05-11
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2018 630756832 2019-05-08 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 106
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2019-05-08
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2017 630756832 2018-06-25 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 98
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2018-06-25
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2016 630756832 2017-06-12 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 96
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2017-06-09
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2015 630756832 2016-10-07 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 93
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2016-10-07
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2014 630756832 2015-08-07 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 93
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2015-08-07
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2013 630756832 2014-06-19 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 94
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing JAMES HOLLAND
BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. MPP 2012 630756832 2013-10-09 BAYOU LA BATRE AREA HEALTH DEVELOPMENT BOARD, INC. 94
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1981-06-01
Business code 621498
Sponsor’s telephone number 2518242174
Plan sponsor’s address P O BOX 769, BAYOU LA BATRE, AL, 365090769

Signature of
Role Plan administrator
Date 2013-10-08
Name of individual signing JAMES HOLLAND

Incorporator

Name Role
ROBERTSON, RALSTON H Incorporator
TEMME, M G Incorporator
BRYANT, WILLIE LOUISE Incorporator

Related by officers

ROBERTSON, RALSTON H

Mobilux Corporation Bayou Telephone Company, Inc. First Alabama Bank of Mobile County Jedelin Construction Company, Inc. The Medical Clinic Board of the City of Bayou La Batre, Alabama Medusa Leasing, Inc. Thelma K., Inc.

Related by address

BAYOU LA BATRE, AL

The Bayou Oil Company, Inc. Bayou Trawl Boards & Marine Supply, Inc. Bryant Enterprises, Inc. Bryant Trawlers, Inc. D & H Furniture and Appliance, Inc. Cindy Lynn, Inc. Fishboats, Inc. Forward Pass, Inc. G & S Boats, Inc. Graham Charter Corporation

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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