| Name: | Revival Psychiatry LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 11 Aug 2021 (3 years ago) (Companies founded in August 2021) |
| Entity Number: | 000-877-545 |
| Register Number: | 000877545 |
| ZIP code: | 35613 (Companies in Limestone, 35613) |
| County: | Limestone |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 15884 E Limestone RdAthens, AL 35613 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073285987 | 2021-09-29 | 2021-09-29 | 15884 E LIMESTONE RD, ATHENS, AL, 356137522, US | 15884 E LIMESTONE RD, ATHENS, AL, 356137522, US | |||||||||||||
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| Phone | +1 256-431-6469 |
Authorized person
| Name | JACOB SCOTT |
| Role | OWNER |
| Phone | 2564316469 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Smith, Jarrod | Organizer | 15884 E Limestone RdAthens, AL 35613 |
| Scott, Jacob | Organizer | 15884 E Limestone RdAthens, AL 35613 |
| Smith, Naquita | Organizer | 15884 E Limestone RdAthens, AL 35613 |
| Name | Role | Address |
|---|---|---|
| Scott, Jacob | Agent | 15884 E Limestone RdAthens, AL 35613 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
