| Entity Name: | GENOA HEALTHCARE OF FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
GENOA HEALTHCARE OF FLORIDA, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 07 Sep 2005 (20 years ago) |
| Date of dissolution: | 23 Mar 2018 (7 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 Mar 2018 (7 years ago) |
| Document Number: | L05000090788 |
| FEI/EIN Number |
651258766
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 18300 Cascade Avenue South, Tukwila, WA, 98188, US |
| Mail Address: | 18300 Cascade Avenue South, Tukwila, WA, 98188, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1366540239 | 2006-09-21 | 2023-03-07 | PO BOX 77030, MINNEAPOLIS, MN, 554807730, US | 1437 S BELCHER RD, CLEARWATER, FL, 337642829, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 253-218-0830 |
| Fax | 2532174306 |
| Phone | +1 727-533-9073 |
| Fax | 7275339184 |
Authorized person
| Name | RYAN NIEMEYER |
| Role | CONTROLLER |
| Phone | 2532180830 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | No |
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336L0003X - Long Term Care Pharmacy |
| License Number | PH22102 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031630000 |
| State | FL |
| Issuer | NCPDP PROVIDER IDENTIFICATION NUMBER |
| Number | 1020356 |
| Issuer | BOP LICENSE |
| Number | PH22102 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CORPORATION SERVICE COMPANY | Agent | - |
| Zuern Makenzie | Director | 18300 Cascade Avenue South, Tukwila, WA, 98188 |
| Figueroa John | President | 18300 Cascade Avenue South, Tukwila, WA, 98188 |
| Breed Victor | Chief Financial Officer | 18300 Cascade Avenue South, Tukwila, WA, 98188 |
| Vucurevich David | Chief Operating Officer | 18300 Cascade Avenue South, Tukwila, WA, 98188 |
| Peterson Mark | Exec | 18300 Cascade Avenue South, Tukwila, WA, 98188 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2018-03-23 | - | - |
| REGISTERED AGENT NAME CHANGED | 2017-07-24 | CORPORATION SERVICE COMPANY | - |
| REGISTERED AGENT ADDRESS CHANGED | 2017-07-24 | 1201 HAYS ST., TALLAHASSEE, FL 32301 | - |
| LC STMNT OF RA/RO CHG | 2017-07-24 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-30 | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 | - |
| CHANGE OF MAILING ADDRESS | 2016-03-30 | 18300 Cascade Avenue South, Suite 251, Tukwila, WA 98188 | - |
| LC AMENDMENT | 2014-07-07 | - | - |
| LC AMENDMENT | 2010-12-17 | - | - |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2018-03-23 |
| CORLCRACHG | 2017-07-24 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-04-11 |
| LC Amendment | 2014-07-07 |
| ANNUAL REPORT | 2014-04-07 |
| ANNUAL REPORT | 2013-04-05 |
| ANNUAL REPORT | 2012-02-13 |
| ANNUAL REPORT | 2011-03-15 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
