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GENOA HEALTHCARE OF FLORIDA, LLC - Florida Company Profile

Company Details

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.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act

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

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366540239 2006-09-21 2023-03-07 PO BOX 77030, MINNEAPOLIS, MN, 554807730, US 1437 S BELCHER RD, CLEARWATER, FL, 337642829, US

Contacts

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

Key Officers & Management

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

Events

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 - -

Documents

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