| Entity Name: | TED SLONE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Aug 2008 (16 years ago) |
| Document Number: | L08000080544 |
| FEI/EIN Number | 76-0044524 |
| Address: | 8303 S SUNCOAST BLVD, HOMOSASSA, FL, 34446, US |
| Mail Address: | 8303 S SUNCOAST BLVD, HOMOSASSA, FL, 34446, US |
| ZIP code: | 34446 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316194988 | 2008-08-26 | 2008-08-26 | 1122 SE KINGS BAY DR, CRYSTAL RIVER, FL, 344294645, US | 8303 S SUNCOAST BLVD, HOMOSASSA, FL, 344465028, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 352-795-6929 |
| Fax | 3527945086 |
Authorized person
| Name | DAWN GOODPASTER |
| Role | MANAGING PARTNER |
| Phone | 3527956929 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 267384300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 291921400 |
| State | FL |
| Issuer | BLUE CROSS |
| Number | V3150 |
| Name | Role | Address |
|---|---|---|
| Jennings Julie | Agent | 2700 N Leeds Pt, Hernando, FL, 34442 |
| Name | Role | Address |
|---|---|---|
| Herron Michael | Manager | 8303 S SUNCOAST BLVD, HOMOSASSA, FL, 34446 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G08239900224 | SUGARMILL CARE CENTER | EXPIRED | 2008-08-26 | 2013-12-31 | No data | 1122 S E KINGS BAY DR, CRYSTAL RIVER, FL, 34429 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-07 | 2700 N Leeds Pt, Hernando, FL 34442 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-08-21 | Jennings, Julie | No data |
| CHANGE OF MAILING ADDRESS | 2021-05-11 | 8303 S SUNCOAST BLVD, HOMOSASSA, FL 34446 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-07 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-13 |
| AMENDED ANNUAL REPORT | 2021-08-21 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-04-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-04-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
