| Name: | Family Health Care Clinic, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Non-Profit Corporation |
| Status: | Exists |
| Date of registration: | 30 May 1996 (28 years ago) |
| Entity Number: | 000-943-653 |
| Register Number: | 000943653 |
| County: | Elmore |
| Place of Formation: | Mississippi |
| Principal Address: | 4635 HWY 80 EASTPEARL, MS 39208 |
| Registered Office Street Address: | 4037 US 231 STE AWETUMPKA, AL 36093 |
| Registered Office Street Address ZIP Code: | 36093 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588992333 | 2009-12-04 | 2020-04-16 | PO BOX 24116, JACKSON, MS, 392254116, US | 16410 HIGHWAY 72, ROGERSVILLE, AL, 35652, US | |||||||||||||||||||||||||||
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| Phone | +1 601-825-7280 |
| Fax | 6018258130 |
| Phone | +1 256-247-3154 |
| Fax | 2562477960 |
Authorized person
| Name | KARINA MARIE CLAYTON |
| Role | CHIEF FINANCIAL OFFICER |
| Phone | 6018257280 |
Taxonomy
| Taxonomy Code | 261QF0400X - Federally Qualified Health Center (FQHC) |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116364 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| INCORP SERVICES INC | Agent | 3773 HOWARD HUGHES PKWY SUITE 500SLAS VEGAS, NV 89169 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
