| Name: | Southern Blessings Adult and Pediatrics LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 11 Apr 2021 (4 years ago) |
| Date of dissolution: | 11 Dec 2022 |
| Entity Number: | 000-846-237 |
| Register Number: | 000846237 |
| County: | Walker |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 1402 pineview roadJasper, AL 35504 |
| Registered Office Street Address ZIP Code: | 35504 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184204414 | 2021-04-12 | 2021-04-12 | 1402 PINEVIEW RD, JASPER, AL, 355048906, US | 1402 PINEVIEW RD, JASPER, AL, 355048906, US | |||||||||||||||||||||||||
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| Phone | +1 606-302-1233 |
Authorized person
| Name | TIFFANY TOLLIVER |
| Role | OWNER/CRNP |
| Phone | 6063021233 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1003473877 |
| State | AL |
| Issuer | MEDICAID |
| Number | 1-157411 |
| State | AL |
| Name | Role |
|---|---|
| Tolliver, Tiffany | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
