| Entity Name: | LIBERTY I, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Aug 2002 (22 years ago) |
| Document Number: | L02000019697 |
| FEI/EIN Number | 020641018 |
| Address: | 5810 W CYPRESS ST, Tampa, FL, 33607, US |
| Mail Address: | 4655 SALISBURY ROAD, STE 110, JACKSONVILLE, FL, 32256, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588616015 | 2006-05-16 | 2023-12-27 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 5810 W CYPRESS ST STE 5810-A, TAMPA, FL, 336071780, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 813-636-5017 |
| Fax | 8132821166 |
Authorized person
| Name | MR. ROBERT G YOUNG |
| Role | SECRETARY & CAO |
| Phone | 9047331003 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA WAIVER ID |
| Number | 10D1011161 |
| State | FL |
| Issuer | AHCA STATE LICENSE |
| Number | 299992257 |
| State | FL |
| Issuer | MEDICAID |
| Number | 111117900 |
| State | FL |
| Issuer | AHCA STATE LICENSE |
| Number | 299991756 |
| State | FL |
| Issuer | AHCA STATE LICENSE |
| Number | 299992984 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| YOUNG ROBERT GREG | Agent | 4655 SALISBURY ROAD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| CONCIERGE FLORIDA ACQUISITIONS 3, LLC | Authorized Member | 4655 SALISBURY ROAD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| FISHER JEFFREY L | President | 4655 SALISBURY ROAD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Rucker David C | Chief Executive Officer | 4655 Salisbury Rd., Jacksonville, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| YOUNG ROBERT G | Secretary | 4655 SALISBURY ROAD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| THOMA KERI A | Chief Financial Officer | 4655 SALISBURY ROAD, STE 110, JACKSONVILLE, FL, 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000011203 | CONCIERGE HOME CARE | ACTIVE | 2022-01-26 | 2027-12-31 | No data | 4655 SALISBURY ROAD SUITE 110, JACKSONVILLE, FL, 32256 |
| G22000011205 | CONCIERGE HOME CARE | ACTIVE | 2022-01-26 | 2027-12-31 | No data | 4655 SALISBURY ROAD SUITE 110, JACKSONVILLE, FL, 32256 |
| G22000011207 | CONCIERGE HOME CARE | ACTIVE | 2022-01-26 | 2027-12-31 | No data | 4655 SALISBURY ROAD SUITE 110, JACKSONVILLE, FL, 32256 |
| G15000112949 | FUSION HEALTHCARE | ACTIVE | 2015-11-05 | 2025-12-31 | No data | 13923 ICOT BLVD., STE 815, CLEARWATER, FL, 33760 |
| G12000046208 | FUSION HEALTHCARE | EXPIRED | 2012-05-17 | 2017-12-31 | No data | 10901 CORPORATE CIRCLE N, STE A, ST PETERSBURG, FL, 33716 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2021-09-30 | No data | No data |
| LC AMENDMENT | 2021-08-26 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
