| Name: | UnBroken Clinic LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 12 Oct 2022 (2 years ago) (Companies founded in October 2022) |
| Entity Number: | 001-044-300 |
| Register Number: | 001044300 |
| ZIP code: | 35802 (Companies in Madison, 35802) |
| County: | Madison |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 600 Boulevard South SW, Ste 104-PHuntsville, AL 35802 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427760289 | 2022-12-22 | 2022-12-22 | 101 MISTY FOREST DR, PHENIX CITY, AL, 368693492, US | 101 MISTY FOREST DR, PHENIX CITY, AL, 368693492, US | |||||||||||||||||||||||||||
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| Phone | +1 229-460-2361 |
| Fax | 7062871124 |
Authorized person
| Name | MRS. CARRIE PLAYER SEXTON |
| Role | OWNER/EMPLOYEE |
| Phone | 3345457136 |
Taxonomy
| Taxonomy Code | 101Y00000X - Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1376784587 |
| State | GA |
| Issuer | MEDICAID |
| Number | 1376269910 |
| State | GA |
| Name | Role |
|---|---|
| CORPORATE SERVICE CENTER, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Player Sexton, Carrie | Organizer | 5009 Riverchase DrivePhenix City, AL 36870 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
