| Name: | Innovative Health Practice Center LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 25 Sep 2021 (3 years ago) |
| Entity Number: | 000-912-749 |
| Register Number: | 000912749 |
| County: | Tuscaloosa |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 5025 Overbrook RoadTuscaloosa, AL 35405 |
| Registered Office Street Address ZIP Code: | 35405 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952063380 | 2021-10-13 | 2021-10-13 | PO BOX 706, COTTONDALE, AL, 354530108, US | 5025 OVERBROOK RD, TUSCALOOSA, AL, 354055774, US | |||||||||||||
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| Phone | +1 205-462-3255 |
Authorized person
| Name | LATONIA MITCHELL |
| Role | OWNER |
| Phone | 2054623255 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role |
|---|---|
| Mitchell, Latonia | Agent |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
