| Name: | Shalom Family Practice and Medical Spa LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 31 Jan 2023 (2 years ago) (Companies founded in January 2023) |
| Entity Number: | 001-060-547 |
| Register Number: | 001060547 |
| ZIP code: | 35805 (Companies in Madison, 35805) |
| County: | Madison |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 2101 West Clinton Avenue Suite 102Huntsville, AL 35805 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154020667 | 2023-02-23 | 2023-04-11 | 333 WHITESPORT DR SW STE 304, HUNTSVILLE, AL, 358013455, US | 333 WHITESPORT DR SW STE 304, HUNTSVILLE, AL, 358013455, US | |||||||||||||||
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| Phone | +1 256-469-0350 |
| Fax | 2562913611 |
Authorized person
| Name | DR. IBUKUNOLUWA PICKENS |
| Role | OWNER/D.O. |
| Phone | 2564690350 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Pendergrass, J Clark | Agent | 2101 West Clinton Avenue Suite 102Huntsville, AL 35805 |
| Name | Role | Address |
|---|---|---|
| Pendergrass, J Clark | Organizer | 2101 West Clinton Avenue Suite 102Huntsville, AL 35805 |
Date of last update: 17 Aug 2024
Sources: Alabama Secretary of State
