| Name: | The Health Care Authority of the City of Enterprise, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 16 Mar 1961 (64 years ago) (Companies founded in March 1961) |
| Entity Number: | 000-742-555 |
| Register Number: | 000742555 |
| Historical Names: |
Enterprise Hospital Board
|
| Place of Formation: | Alabama |
| Principal Address: | ---, AL |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649389610 | 2006-08-30 | 2023-04-17 | 300 PLAZA DR, ENTERPRISE, AL, 363303311, US | 300 PLAZA DR, ENTERPRISE, AL, 363303311, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-347-9541 |
| Fax | 3343475070 |
Authorized person
| Name | MR. WESLEY M. AVERETT |
| Role | ADMINISTRATOR |
| Phone | 3343479541 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | N1602 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | N1602 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | N1602 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | DME SUPPLIER |
| Number | 0601900001 |
| State | AL |
| Issuer | MEDICAID |
| Number | 4753200S |
| State | AL |
| Issuer | BLUE CROSS/BLUE SHIELD |
| Number | 010605 |
| State | AL |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 1994-12-30 | Name Change | Enterprise Hospital Board | The Health Care Authority of the City of Enterprise, Inc. |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
