| Name: | SHA Diabetes Center, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Mar 2019 (6 years ago) |
| Entity Number: | 000-548-255 |
| Register Number: | 000548255 |
| ZIP code: | 36330 |
| County: | Coffee |
| Place of Formation: | Coffee County |
| Registered Office Street Address: | 113 COMMONWEALTH COURTENTERPRISE, AL 36330 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063293603 | 2023-10-10 | 2024-01-12 | 172 LUDS WAY,, P. O. BOX 8803, DOTHAN, AL, 363048803, US | 172 LUDS WAY, DOTHAN, AL, 363048803, US | |||||||||||||||||
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| Phone | +1 334-778-7090 |
| Phone | +1 334-475-0646 |
| Fax | 3348888445 |
Authorized person
| Name | DR. TAI BOLAJI |
| Role | DR./CEO |
| Phone | 3347787090 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BOLAJI, TAI | Agent | 113 COMMONWEALTH COURTENTERPRISE, AL 36330 |
| Name | Role | Address |
|---|---|---|
| BOLAJI, TAI | Organizer | 113 COMMONWEALTH COURTENTERPRISE, AL 36330 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
