| Entity Name: | GOOD SAMARITAN VILLAGE, LLLP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Limited Partnership |
| Status: | Inactive |
| Date Filed: | 13 Apr 2018 (7 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | A18000000154 |
| Address: | 26442 WHIRLAWAY TERRACE, WESLEY CHAPEL, 33544 |
| Mail Address: | 26442 WHIRLAWAY TERRACE, WESLEY CHAPEL, FL, 33544 |
| ZIP code: | 33544 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114407574 | 2018-08-15 | 2018-08-15 | 26442 WHIRLAWAY TER, WESLEY CHAPEL, FL, 335441552, US | 26442 WHIRLAWAY TER, WESLEY CHAPEL, FL, 335441552, US | |||||||||||||||||||||||||
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| Phone | +1 203-558-4189 |
| Phone | +1 860-794-6457 |
Authorized person
| Name | DERRICK APPIAH |
| Role | MEMBER |
| Phone | 2035584189 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| License Number | 714547 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 714547 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DERRICK APPIAH K | Agent | 26442 WHIRLAWAY TERRACE, WESLEY CHAPEL, FL, 33544 |
| Name | Role | Address |
|---|---|---|
| DERRICK APPIAH K | General Partner | 26442 WHIRLAWAY TERRACE, WESLEY CHAPEL, FL, 33544 |
| ANTOINETTE KOOMSON | General Partner | 26442 WHIRLAWAY TERRACE, WESLEY CHAPEL, FL, 33544 |
| FAY EVANS | General Partner | 26442 WHIRLAWAY TERRACE, WESLEY, FL, 33544 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| Domestic LP | 2018-04-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
