Alabama Healthcare Advantage North

Details

Name:	Alabama Healthcare Advantage North
Jurisdiction:	Alabama
Legal type:	Domestic Non-Profit Corporation
Status:	Dissolved
Date of registration:	16 Oct 2014 (10 years ago)
Date of dissolution:	21 Apr 2017
Entity Number:	000-320-772
Register Number:	000320772
Historical Names:	Alabama Healthcare Advantage North .labama Healthcare Advantage North
ZIP code:	36117
County:	Montgomery
Place of Formation:	Montgomery County
Principal Address:	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
Registered Office Street Address:	2740 ZELDA ROADMONTGOMERY, AL 36106

Activities TO BECOME A MEDICAID RCO IN REGION

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1881059509

2015-12-22

8650 MINNIE BROWN RD STE 224, MONTGOMERY, AL, 361177433, US

Contacts

Phone

+1 334-215-3985

Authorized person

Taxonomy

Taxonomy Code	251K00000X - Public Health or Welfare Agency
State	AL
Is Primary	Yes

Name	Role	Address
MOORE, BRIAN W	Agent	2740 ZELDA ROADMONTGOMERY, AL 36106

Name	Role	Address
WHITNEY, TODD W	Director	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
CAMERIO, MICHAEL L	Director	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
ENSLEY, RICHARD	Director	223 DRIFTWOOD LANETALLASSEE, AL 36078
REDDEN, JOHN	Director	231 WALBASH DRIVEMONTGOMERY, AL 36116
TAYLOR, DOUG	Director	7472 SOUTH TUSCON WAY SUITE 100CENTENNIAL, CO 80112
WARREN, EDDIE	Director	714 NORTH THREE NOTCH STREETTROY, AL 36081
HOWARD, RON	Director	312 JAMES STREETTALLASSEE, AL 36078
ADAMS, PATTY	Director	MED 3000 5020 COMMERCE PARK CRPENSACOLA, FL 32505
RAHN, ED	Director	1102 A1A NORTH SUITE 202PONTE VEDRA BEACH, FL 32802
PAGE, EARL	Director	MED 3000 5020 COMMERCE PARK CRPENSACOLA, FL 32505
NUTHI, SRIKRISHNA	Director	2705 BOULDER CIRCLE SEHUNTSVILLE, AL 35801
REDMOND-HYDER, DEBBIE	Director	475 PROVIDENCE MAIN ST NW STE 202HUNTSVILLE, AL 35806
KINZER, CLAUDE	Director	810 FRANKLIN STREET STE BHUNTSVILLE, AL 35801
PENDERGRASS, BEN	Director	600 WASHINGTON STREETHUNTSVILLE, AL 35801
BORDEN, CHRIS	Director	805 COUNTY ROAD 1539CULLMAN, AL 35058
FOREMAN, LISA	Director	3480 BROAD STREETPHIL CAMPBELL, AL 35581
COPELAND, SUSAN	Director	725 E TOWNE LAKE PKWYOPELIKA, AL 36804
CHASE, JAYNE	Director	4615 COUNTY ROAD 15FLORENCE, AL 35633
PATCHEN, JASON	Director	3505 E FRONTAGE ROAD, STE 250TAMPA, FL 33607
HUNTER, JESSE	Director	7700 FORSYTH BLVDST. LOUIS, MO 63105

Name	Role	Address
CAMERIO, MICHAEL L	Incorporator	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
WHITNEY, TODD W	Incorporator	8650 MINNIE BROWN RD SUITE 224MONTGOMERY, AL 36117
ENSLEY, RICHARD	Incorporator	223 DRIFTWOOD LANETALLASSEE, AL 36078

Event Date	Event Type	Old Value	New Value
2015-09-29	Name Change	.labama Healthcare Advantage North	Alabama Healthcare Advantage North
2014-12-23	Name Change	Alabama Healthcare Advantage North	.labama Healthcare Advantage North

Date of last update: 03 Aug 2024