| Entity Name: | ATLANTIC HOME HEALTH AGENCY OF SOUTH FLORIDA, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Jul 2008 (16 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 21 May 2021 (4 years ago) |
| Document Number: | L08000073164 |
| FEI/EIN Number | 263100811 |
| Mail Address: | 4655 Salisbury Rd, Jacksonville, FL, 32256, US |
| Address: | 360 Columbia Dr., Ste 104, West Palm Beach, FL, 33409-1976, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598900060 | 2008-12-11 | 2024-08-28 | 4655 SALISBURY RD STE 110, JACKSONVILLE, FL, 322560957, US | 360 COLUMBIA DR STE 104, WEST PALM BEACH, FL, 334091976, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-733-1003 |
| Fax | 9044488855 |
| Phone | +1 561-447-6602 |
| Fax | 5614476603 |
Authorized person
| Name | MR. ROBERT GREG YOUNG |
| Role | SECRETARY |
| Phone | 9047331003 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA |
| Number | 10D2108489 |
| State | FL |
| Issuer | AHCA LICENSE - BRANCH |
| Number | 299994439 |
| State | FL |
| Issuer | AHCA LICENSE - PARENT |
| Number | 299993554 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Young Robert G | Agent | 4655 Salisbury Rd, Jacksonville, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| WGR HOLDINGS BOCA, LLC | Auth | 4655 SALISBURY RD, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Rucker David C | Chief Executive Officer | 4655 Salisbury Rd, Jacksonville, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Fisher Jeffrey L | President | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Young Robert G | Secretary | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| Thoma Keri A | Chief Financial Officer | 4655 Salisbury Rd, JACKSONVILLE, FL, 32256 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000169229 | CONCIERGE HOME CARE | ACTIVE | 2021-12-21 | 2026-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| G21000166907 | CONCIERGE HOME CARE | ACTIVE | 2021-12-17 | 2026-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| G21000165895 | CONCIERGE HOME CARE | ACTIVE | 2021-12-16 | 2026-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| G16000045718 | FIVE STAR HOME CARE | ACTIVE | 2016-05-09 | 2026-12-31 | No data | 4655 SALISBURY ROAD, SUITE 110, JACKSONVILLE, FL, 32256 |
| G12000053557 | FIVE STAR HOME CARE | EXPIRED | 2012-06-06 | 2017-12-31 | No data | 7025 BERACASA WAY, SUITE 104, BOCA RATON, FL, 33433 |
| G11000079193 | ALC HOME HEALTH | EXPIRED | 2011-08-09 | 2016-12-31 | No data | 7025 BERACASA WAY, STE 104, BOCA RATON, FL, 33433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-02 | 360 Columbia Dr., Ste 104, West Palm Beach, FL 33409-1976 | No data |
| LC AMENDMENT | 2021-05-21 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-14 | 4655 Salisbury Rd, Suite 110, Jacksonville, FL 32256 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-14 | 360 Columbia Dr., Ste 104, West Palm Beach, FL 33409-1976 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-25 | Young, Robert Greg | No data |
| LC AMENDMENT | 2014-02-03 | No data | No data |
| LC AMENDMENT | 2012-12-10 | No data | No data |
| LC AMENDMENT | 2011-09-16 | No data | No data |
| LC AMENDMENT | 2009-07-29 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-13 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-02-04 |
| LC Amendment | 2021-05-21 |
| ANNUAL REPORT | 2021-04-14 |
| AMENDED ANNUAL REPORT | 2020-06-25 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-04-06 |
| ANNUAL REPORT | 2018-03-26 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
