| Name: | Heritage Health Care & Rehab, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 25 Nov 2003 (21 years ago) |
| Entity Number: | 000-232-285 |
| Register Number: | 000232285 |
| ZIP code: | 35406 |
| County: | Tuscaloosa |
| Place of Formation: | Tuscaloosa County |
| Principal Address: | TUSCALOOSA, AL |
| Registered Office Street Address: | 1101 SNOWS MILL AVETUSCALOOSA, AL 35406 |
| Authorized Capital: | $1,000 |
Activities
OPERATE A SKILLED NURSING FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184719247 | 2006-10-04 | 2020-08-22 | 1101 SNOWS MILL AVENUE, TUSCALOOSA, AL, 354062015, US | 1101 SNOWS MILL AVENUE, TUSCALOOSA, AL, 354062015, US | |||||||||||||||||||||||||
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| Phone | +1 205-759-5179 |
| Fax | 2057595216 |
Authorized person
| Name | MR. GEORGE L JACKSON |
| Role | ADMINISTRATOR |
| Phone | 2057595179 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 12691 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4754110S |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HERITAGE HEALTH CARE & REHAB, INC. 401(K) RETIREMENT PLAN | 2023 | 630714401 | 2024-07-11 | HERITAGE HEALTH CARE & REHAB, INC | 89 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-11 |
| Name of individual signing | AMY PHILPOT |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1993-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 2057595179 |
| Plan sponsor’s address | 1101 SNOWS MILL AVENUE, TUSCALOOSA, AL, 354062015 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-09 |
| Name of individual signing | AMY PHILPOT |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1993-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 2057595179 |
| Plan sponsor’s address | 1101 SNOWS MILL AVENUE, TUSCALOOSA, AL, 354062015 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-05 |
| Name of individual signing | AMY PHILPOT |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 1993-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 2057595179 |
| Plan sponsor’s address | 1101 SNOWS MILL AVENUE, TUSCALOOSA, AL, 354062015 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-30 |
| Name of individual signing | AMY PHILPOT |
| Name | Role |
|---|---|
| JACKSON, GEORGE L | Agent |
| Name | Role |
|---|---|
| JACKSON, EDWARD | Incorporator |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5510577004 | 2020-04-05 | 0459 | PPP | 1101 Snows Mill Avenue, TUSCALOOSA, AL, 35406-2015 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
