| Entity Name: | PALM BEACH HOME CARE AGENCY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 10 Jun 2003 (22 years ago) |
| Date of dissolution: | 13 Jun 2014 (11 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 13 Jun 2014 (11 years ago) |
| Document Number: | L03000020781 |
| FEI/EIN Number | 201129215 |
| Address: | 1700 N DIXIE HIGHWAY, SUITE 148, BOCA RATON, FL, 33432 |
| Mail Address: | 1700 N DIXIE HIGHWAY, SUITE 148, BOCA RATON, FL, 33432 |
| ZIP code: | 33432 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184992802 | 2011-12-08 | 2012-01-19 | 1700 N DIXIE HWY STE 148, BOCA RATON, FL, 334321808, US | 1700 N DIXIE HWY STE 148, BOCA RATON, FL, 334321808, US | |||||||||||||||||||||||||
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| Phone | +1 561-338-7775 |
| Fax | 5613386177 |
Authorized person
| Name | MRS. MARTHA TOVAR COSTON |
| Role | ADMINISTRATOR |
| Phone | 5613387775 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 228299 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 6861903 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COSTON MARTHA T | Agent | 1700 N DIXIE HIGHWAY, BOCA RATON, FL, 33432 |
| Name | Role | Address |
|---|---|---|
| COSTON MARTHA T | Manager | 1700 N DIXIE HIGHWAY STE.148, BOCA RATON,, FL, 33432 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000174698 | PALM BEACH HOME CARE | EXPIRED | 2009-11-12 | 2014-12-31 | No data | 2499 GLADES RD., SUITE 105, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2014-06-13 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-02-07 | 1700 N DIXIE HIGHWAY, SUITE 148, BOCA RATON, FL 33432 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-12-14 | 1700 N DIXIE HIGHWAY, SUITE 148, BOCA RATON, FL 33432 | No data |
| CHANGE OF MAILING ADDRESS | 2011-12-14 | 1700 N DIXIE HIGHWAY, SUITE 148, BOCA RATON, FL 33432 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2014-06-13 |
| ANNUAL REPORT | 2013-03-21 |
| ANNUAL REPORT | 2012-02-07 |
| ANNUAL REPORT | 2011-12-14 |
| ANNUAL REPORT | 2011-02-15 |
| ANNUAL REPORT | 2010-01-28 |
| ANNUAL REPORT | 2009-02-21 |
| ANNUAL REPORT | 2008-01-24 |
| ANNUAL REPORT | 2007-04-28 |
| ANNUAL REPORT | 2006-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
