| Name: | Physicians Choice Dialysis of Jacksonville, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Foreign Limited Liability Company |
| Status: | Withdrawn |
| Date of registration: | 07 Dec 2007 (17 years ago) |
| Entity Number: | 000-614-556 |
| Register Number: | 000614556 |
| ZIP code: | 36104 |
| County: | Montgomery |
| Place of Formation: | Delaware |
| Principal Address: | 211 COMMERCE CT STE 104POTTSTOWN, PA 19464 |
| Registered Office Street Address: | 150 S PERRY STMONTGOMERY, AL 36104 |
Activities
DIALYSIS CENTER
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386829489 | 2008-01-08 | 2009-10-02 | 211 COMMERCE CT, SUITE 104, POTTSTOWN, PA, 194643483, US | 331 HENRY ROAD SW, JACKSONVILLE, AL, 36265, US | |||||||||||||||||||||
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| Phone | +1 610-495-8900 |
| Fax | 6104958560 |
Authorized person
| Name | MRS. RHONDA B PALUMBO |
| Role | DIRECTOR OF CONTRACTS/HR |
| Phone | 6104958900 |
Taxonomy
| Taxonomy Code | 261QE0700X - End-Stage Renal Disease (ESRD) Treatment Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DIA2625D |
| State | AL |
| Name | Role | Address |
|---|---|---|
| CSC LAWYERS INCORPORATING SVC INC | Agent | 2711 CENTERVILLE ROAD, SUITE 400WILMINGTON, DE 19808 |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
