| Entity Name: | PELICAN HAVEN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 10 Mar 2009 (16 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L09000023836 |
| FEI/EIN Number | 80-0366794 |
| Address: | 4310 14TH STREET SW, LEHIGH ACRES, FL 33971 |
| Mail Address: | 12440 MUDDY CREEK LANE, FORT MYERS, FL 33913 |
| ZIP code: | 33971 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093022980 | 2010-09-13 | 2010-09-13 | 4310 14TH ST SW, LEHIGH ACRES, FL, 339762731, US | 4310 14TH ST SW, LEHIGH ACRES, FL, 339762731, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 239-674-7051 |
Authorized person
| Name | YVONNE JULMEUS |
| Role | DIRECTOR/OWNER |
| Phone | 2398720718 |
Taxonomy
| Taxonomy Code | 171W00000X - Contractor |
| License Number | 001926400 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | 089390 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001925800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001302600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 001926400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JULMEUS, YVONNE | Agent | 12440 MUDDY CREEK LANE, FORT MYERS, FL 33913 |
| Name | Role | Address |
|---|---|---|
| JULMEUS, YVONNE | Managing Member | 12440 MUDDY CREEK LANE, FORT MYERS, FL 33913 |
| JULMEUS, EVANEL | Managing Member | 12440 MUDDY CREEK LANE, FORT MYERS, FL 33913 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REINSTATEMENT | 2011-11-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2011-11-26 |
| ANNUAL REPORT | 2010-05-04 |
| Florida Limited Liability | 2009-03-10 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
