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Northeast Alabama Health Services, Inc.

Details

Name: Northeast Alabama Health Services, Inc.
Jurisdiction: Alabama
Legal type: Domestic Non-Profit Corporation
Status: Exists
Date of registration: 28 Nov 1978 (46 years ago)
Entity Number: 000-759-523
Register Number: 000759523
Historical Names: Jackson County Primary Health Care Board
County: Jackson
Place of Formation: Jackson County
Principal Address: SCOTTSBORO, AL
Registered Office Street Address: 309 TAYLOR STREETSCOTTSBORO, AL 35768
Registered Office Street Address ZIP Code: 35768

Activities PROMOTE HEALTH CARE DELIVERY

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1831346386 2008-08-26 2024-05-28 3840 GAULT AVE N, FORT PAYNE, AL, 359675211, US 3840 GAULT AVE N, FORT PAYNE, AL, 359675211, US

Contacts
Phone +1 256-844-4975
Fax 2568444978

Authorized person
Name JAMES P ALLEN JR.
Role CEO
Phone 2562595313

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 105198
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2022 630760576 2024-01-31 NORTHEAST ALABAMA HEALTH SERVICES, INC 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Plan sponsor’s address 309 TAYLOR ST, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2021 630760576 2023-01-12 NORTHEAST ALABAMA HEALTH SERVICES, INC 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Plan sponsor’s address 309 TAYLOR ST, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2020 630760576 2021-12-15 NORTHEAST ALABAMA HEALTH SERVICES, INC. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2018 630760576 2020-01-30 NORTHEAST ALABAMA HEALTH SERVICES, INC. 25
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2018 630760576 2020-02-05 NORTHEAST ALABAMA HEALTH SERVICES, INC. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2017 630760576 2019-01-25 NORTHEAST ALABAMA HEALTH SERVICES, INC. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2016 630760576 2018-01-08 NORTHEAST ALABAMA HEALTH SERVICES, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2015 630760576 2017-01-12 NORTHEAST ALABAMA HEALTH SERVICES, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2014 630760576 2015-12-22 NORTHEAST ALABAMA HEALTH SERVICES, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768
NORTHEAST ALABAMA HEALTH SERVICES, INC. 403B 2013 630760576 2014-10-14 NORTHEAST ALABAMA HEALTH SERVICES, INC. 17
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2005-09-23
Business code 621498
Sponsor’s telephone number 2562595313
Plan sponsor’s address 309 TAYLOR STREET, SCOTTSBORO, AL, 35768

Agent

Name Role
CULPEPPER, DEBORAH F Agent

Incorporator

Name Role
HOUSER, STELLA Incorporator
MCGRIFF, TONI Incorporator
RICHARDSON, BEN Incorporator

Events

Event Date Event Type Old Value New Value
2002-05-30 Name Change Jackson County Primary Health Care Board Northeast Alabama Health Services, Inc.

Related by officers

No related officers

Related by address

SCOTTSBORO, AL

Abercrombie's Tire Center, Inc. I. E. Airheart & Son, Inc. Alabama Leasing Corporation Allen Mobile Home Parks, Inc. Benham Corporation Copeland Tire Company, Inc. Derrick's Department Store, Inc. Farm Bureau Service Center of Jackson, Inc. Farm Service Chemical Co., Inc. Fred's Dollar Store of Scottsboro, Inc.

Date of last update: 15 Aug 2024

Sources: Alabama Secretary of State

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