| Entity Name: | CARE PROVIDER SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Inactive |
| Date Filed: | 07 Oct 1999 (25 years ago) |
| Document Number: | F99000005483 |
| FEI/EIN Number | 582121980 |
| Address: | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Mail Address: | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Place of Formation: | GEORGIA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083758312 | 2007-02-19 | 2020-08-22 | 2979 PGA BLVD STE 225, PALM BEACH GARDENS, FL, 334102911, US | 2979 PGA BLVD STE 225, PALM BEACH GARDENS, FL, 334102911, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-630-0884 |
| Fax | 5612736184 |
Authorized person
| Name | ELIZABETH FAGO |
| Role | PRESIDENT |
| Phone | 5616263300 |
Taxonomy
| Taxonomy Code | 332BN1400X - Nursing Facility Supplies (DME) |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 4581749 |
| State | TN |
| Issuer | MEDICAID |
| Number | 90000092 |
| State | KY |
| Name | Role | Address |
|---|---|---|
| STEIER E. JOSEPH I | Director | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Name | Role | Address |
|---|---|---|
| STEIER E. JOSEPH I | Chief Executive Officer | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Name | Role | Address |
|---|---|---|
| HARRISON JOHN | Chief Financial Officer | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Name | Role | Address |
|---|---|---|
| ADAMS SANDRA L | Vice President | 12201 BLUEGRASS PARKWAY, LOUISVILLE, KY, 40299 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2011-07-07 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
