| Name: | Coosa Valley HomeCare, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Jun 2009 (16 years ago) |
| Entity Number: | 000-435-440 |
| Register Number: | 000435440 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Principal Address: | MONTGOMERY, AL |
| Registered Office Street Address: | 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104 |
Activities
HEALTH CARE SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871723841 | 2009-07-23 | 2024-05-24 | PO BOX 51266, LAFAYETTE, LA, 705051266, US | 209 W SPRING ST, SUITE 305, SYLACAUGA, AL, 351502973, US | |||||||||||||||||||||||||
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| Phone | +1 337-233-1307 |
| Fax | 3372335764 |
| Phone | +1 256-208-0087 |
| Fax | 2562080301 |
Authorized person
| Name | MR. JOSHUA L. PROFFITT |
| Role | PRESIDENT |
| Phone | 3372331307 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 115400 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role |
|---|---|
| SYLACAUGA HEALTH CARE AUTHORITY | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
