| Name: | Theta Home Health Care, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Corporation |
| Status: | Exists |
| Date of registration: | 28 Jun 1994 (30 years ago) |
| Entity Number: | 000-904-648 |
| Register Number: | 000904648 |
| County: | Montgomery |
| Place of Formation: | Florida |
| Principal Address: | 3600 VINELAND ROAD STE 114ORLANDO, FL 32811 |
| Registered Office Street Address: | 2 NORTH JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Registered Office Street Address ZIP Code: | 36104 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275594202 | 2006-03-29 | 2024-04-15 | PO BOX 27968, SALT LAKE CITY, UT, 841270968, US | 1986 AIRPORT BLVD, ALEXANDER CITY, AL, 350103354, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-246-1226 |
| Fax | 4076482297 |
| Phone | +1 256-234-0873 |
| Fax | 2563290517 |
Authorized person
| Name | MRS. ROBIN L MENCHEN |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 4078224600 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009710150 |
| State | AL |
| Name | Role |
|---|---|
| NATIONAL REGISTERED AGENTS INC | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
