| Name: | Providence Home Medical Services, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 Jul 2013 (11 years ago) |
| Entity Number: | 000-283-298 |
| Register Number: | 000283298 |
| ZIP code: | 35501 |
| County: | Walker |
| Place of Formation: | Walker County |
| Registered Office Street Address: | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
Activities
PROVIDE DURABLE MEDICAL EQUIPMENT AND RELATED SERVICES
| Type | Company Name | Company Number | State |
|---|---|---|---|
| Headquarter of | Providence Home Medical Services, LLC, MISSISSIPPI | 1420854 | MISSISSIPPI |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982030193 | 2013-09-19 | 2019-11-12 | 406 MEDICAL CENTER DR., JASPER, AL, 355013400, US | 6701 AIRPORT BLVD., STE. B-121, MOBILE, AL, 366086705, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 205-221-8200 |
| Fax | 2052218270 |
| Phone | +1 251-633-7491 |
| Fax | 2516337492 |
Authorized person
| Name | LISA J. WELLS |
| Role | EXECUTIVE DIRECTOR |
| Phone | 2052218258 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 163809 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| WRIGHT, ANESSA B | Agent | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
| Name | Role | Address |
|---|---|---|
| WRIGHT, ANESSA B | Organizer | 406 MEDICAL CENTER DRIVEJASPER, AL 35501 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
