| Name: | Providence Healthcare Services |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Dissolved |
| Date of registration: | 16 Sep 1986 (38 years ago) |
| Date of dissolution: | 18 Nov 2015 |
| Entity Number: | 000-785-432 |
| Register Number: | 000785432 |
| County: | Mobile |
| Place of Formation: | Mobile County |
| Principal Address: | MOBILE, AL |
| Registered Office Street Address: | 6801 AIRPORT BLVDMOBILE, AL 36685 |
| Registered Office Street Address ZIP Code: | 36685 |
Activities
SUPPORT CHARITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689934085 | 2012-05-21 | 2012-05-21 | PO BOX 850489, MOBILE, AL, 366850489, US | 6701 AIRPORT BLVD, SUITE C132, MOBILE, AL, 366086705, US | |||||||||||||||||||||||
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| Phone | +1 251-342-3949 |
| Fax | 2516313361 |
| Phone | +1 251-631-3501 |
| Fax | 2516313504 |
Authorized person
| Name | MR. CLARK P. CHRISTIANSON |
| Role | PRESIDENT |
| Phone | 2516331660 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| License Number | 1-071676 |
| State | AL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHRISTIANSON, CLARK | Agent | 600 AZALEA ROADMOBILE, AL 36609 |
| Name | Role |
|---|---|
| KILBORN, VINCENT F III | Incorporator |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
