| Name: | Chattahoochee Hospice, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 16 Feb 1983 (42 years ago) (Companies founded in February 1983) |
| Entity Number: | 000-814-237 |
| Register Number: | 000814237 |
| ZIP code: | 36854 (Companies in Chambers, 36854) |
| County: | Chambers |
| Place of Formation: | Chambers County |
| Principal Address: | VALLEY, AL |
| Registered Office Street Address: | # 6 MEDICAL PARKVALLEY, AL 36854 |
Activities
TO SERVICE THE TERMINALLY ILL PERSONS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760454631 | 2006-02-06 | 2020-08-22 | 6 MEDICAL PARK NORTH, VALLEY, AL, 36854, US | 6 MEDICAL PARK NORTH, VALLEY, AL, 36854, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-756-8043 |
| Fax | 3347568059 |
Authorized person
| Name | MRS. KAYE C MAXWELL |
| Role | ADMINISTRATOR |
| Phone | 3347568043 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | 10193 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | 000-107H |
| State | GA |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PIC1524E |
| State | AL |
| Issuer | BC/BS OF AL |
| Number | 010484 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CHASE, EDITH | Incorporator | No data |
| ANDREWS, SCOTT | Incorporator | 4430 REMINGTON ROADMONTGOMERY, AL 36116 |
| CARUSO, ALICE | Incorporator | No data |
| DOWNS, JOE | Incorporator | No data |
| EDWARDS, JANE ELLEN | Incorporator | No data |
| IVES, SHARON | Incorporator | No data |
| LANIER, SMITH II | Incorporator | No data |
| NIX, WILLIAM L | Incorporator | P. O. BOX 466WEST POINT, GA 31833 |
| PERKINS, CHERRY | Incorporator | No data |
| STEELE, ANGEL | Incorporator | No data |
| Name | Role |
|---|---|
| HOLLOWAY, ADRIAN | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
