| Entity Name: | TOWN CENTER FAMILY CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Jun 2007 (18 years ago) |
| Document Number: | L07000068634 |
| FEI/EIN Number | 260470613 |
| Address: | 21 HOSPITAL DRIVE, SUITE 290, PALM COAST, FL, 32164, US |
| Mail Address: | 21 HOSPITAL DRIVE, SUITE 290, PALM COAST, FL, 32164, US |
| ZIP code: | 32164 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396918579 | 2008-04-08 | 2017-03-07 | PO BOX 3123, ST AUGUSTINE, FL, 320853123, US | 21 HOSPITAL DR, STE 290, PALM COAST, FL, 321642380, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 904-824-4990 |
| Phone | +1 386-473-7977 |
| Fax | 3864377732 |
Authorized person
| Name | DR. DONNETTE WILLIAMS |
| Role | OWNER |
| Phone | 3864377977 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME61253 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| License Number | ME61253 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | FL BLUE |
| Number | Y81BD |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Dwyer Marc | Agent | 2517 W. Moody Blvd., Flagler Beach, FL, 32136 |
| Name | Role | Address |
|---|---|---|
| WILLIAMS DONNETTE | Managing Member | 21 HOSPITAL DR, STE 290, PALM COAST, FL, 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-03-15 | Dwyer, Marc | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-15 | 2517 W. Moody Blvd., Flagler Beach, FL 32136 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-21 | 21 HOSPITAL DRIVE, SUITE 290, PALM COAST, FL 32164 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-21 | 21 HOSPITAL DRIVE, SUITE 290, PALM COAST, FL 32164 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-06-14 |
| ANNUAL REPORT | 2019-03-10 |
| ANNUAL REPORT | 2018-04-16 |
| ANNUAL REPORT | 2017-04-23 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-04-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
