| Name: | AseraCare Hospice - Demopolis, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Exists |
| Date of registration: | 24 May 2004 (21 years ago) |
| Entity Number: | 000-606-755 |
| Register Number: | 000606755 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | ONE THOUSAND BEVERLY WAYFORT SMITH, AR 72919 |
| Registered Office Street Address: | 641 SOUTH LAWRENCE STREETMONTGOMERY, AL 36104 |
Activities
HOSPICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578506564 | 2006-06-14 | 2020-07-06 | 3854 AMERICAN WAY STE A, BATON ROUGE, LA, 708164897, US | 482 MCQUEEN SMITH RD S, PRATTVILLE, AL, 360665631, US | |||||||||||||||||||||||||||||||
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| Phone | +1 225-292-2031 |
| Fax | 2252959678 |
| Phone | +1 334-872-1104 |
Authorized person
| Name | PAUL KUSSEROW |
| Role | PRESIDENT |
| Phone | 2252922031 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | 200904081002 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 012-497 |
| Issuer | MEDICAID |
| Number | PIC-1561E |
| State | AL |
| CAGE number | Status | Type | Established | CAGE Update Date | CAGE Expiration | SAM Expiration | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 77K35 | Active | Non-Manufacturer | 2014-09-05 | 2021-11-06 | 2025-11-10 | 2021-11-06 | |||||||||||||||
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| POC | NANCY ANDERSON |
| Phone | +1 479-258-9966 |
| Fax | +1 479-258-9966 |
| Address | 482 MCQUEEN SMITH RD S, PRATTVILLE, AUTAUGA, AL, 36066 5631, UNITED STATES |
Ownership of Offeror Information
| Highest Level Owner | Information not Available |
|---|
| Immediate Level Owner | Information not Available |
|---|
| List of Offerors (0) | Information not Available |
|---|
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY INC | Agent | 251 LITTLE FALLS DRIVEWILMINGTON, DE 19808 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
