| Entity Name: | TRIAD OF ALABAMA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Jun 2003 (22 years ago) |
| Document Number: | M03000001938 |
| FEI/EIN Number | 621762412 |
| Address: | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Mail Address: | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740232982 | 2006-05-16 | 2009-04-14 | PO BOX 1964, DOTHAN, AL, 363021964, US | 2423 MARTIN LUTHER KING JR BLVD, PANAMA CITY, FL, 324054405, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-794-5000 |
Authorized person
| Name | DEBBIE BREWER |
| Role | DIRECTOR, PROVIDER ENROLLMENT |
| Phone | 6154657626 |
Taxonomy
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| License Number | 782 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 782 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026554300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 009941515 |
| State | AL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Pitt Justin D | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Cash W. B | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Hammons Kevin J | Manager | 4000 MERIDIAN BLVD, FRANKLIN, TN, 37067 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-25 | 4000 MERIDIAN BLVD, FRANKLIN, TN 37067 | No data |
| CHANGE OF MAILING ADDRESS | 2008-04-25 | 4000 MERIDIAN BLVD, FRANKLIN, TN 37067 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-24 |
| ANNUAL REPORT | 2021-04-24 |
| ANNUAL REPORT | 2020-06-03 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
