| Entity Name: | ULTIMATE CARE MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Jul 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: | L09000068378 |
| FEI/EIN Number | 270576959 |
| Address: | 3898 VIA POINCIANA, #18, LAKE WORTH, FL, 33467 |
| Mail Address: | 3898 VIA POINCIANA, #18, LAKE WORTH, FL, 33467 |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497035364 | 2011-08-24 | 2011-08-24 | 3898 VIA POINCIANA, SUITE #18, LAKE WORTH, FL, 334672951, US | 3898 VIA POINCIANA, SUITE #18, LAKE WORTH, FL, 334672951, US | |||||||||||||||||||||||||
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| Phone | +1 561-969-2112 |
| Fax | 5616413113 |
Authorized person
| Name | BERNADINE C HENRY |
| Role | ARNP OWNER |
| Phone | 5619692112 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | 9205733 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1356418875 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BERNADINE HENRY | Agent | 8987 BIDDLE CT., WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| HENRY BERNADINE | Managing Member | 8987 BIDDLE CT., WELLINGTON, FL, 33414 |
| ANDERSON JEAN | Managing Member | 8987 BIDDLE CT., WELLINGTON, FL, 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2011-12-04 | BERNADINE, HENRY | No data |
| REINSTATEMENT | 2011-09-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-23 | 3898 VIA POINCIANA, #18, LAKE WORTH, FL 33467 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-23 | 3898 VIA POINCIANA, #18, LAKE WORTH, FL 33467 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-12-04 |
| REINSTATEMENT | 2011-09-28 |
| ANNUAL REPORT | 2010-04-23 |
| Florida Limited Liability | 2009-07-16 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
