| Entity Name: | SUNCREST HOME HEALTH OF TAMPA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Oct 2010 (14 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 16 Nov 2023 (a year ago) |
| Document Number: | L10000107528 |
| FEI/EIN Number | 27-3742788 |
| Address: | 901 Hugh Wallis Road South, Lafayette, LA 70805 |
| Mail Address: | 901 Hugh Wallis Road South, Lafayette, LA 70805 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245872225 | 2019-10-11 | 2021-04-20 | PO BOX 51266, LAFAYETTE, LA, 705051266, US | 311 PARK PLACE BLVD STE 120, CLEARWATER, FL, 337594904, US | |||||||||||||||||||||||||||
|
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| Phone | +1 337-233-1307 |
| Phone | +1 727-260-6680 |
| Fax | 7274418311 |
Authorized person
| Name | NICHOLAS GACHASSIN III |
| Role | EXECUTIVE VICE PRESIDENT |
| Phone | 3372331307 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104652000 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role |
|---|---|
| LHC GROUP, INC. | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000112244 | SUNCREST OMNI | EXPIRED | 2011-11-18 | 2016-12-31 | No data | 510 HOSPITAL DRIVE, STE 100, MADISON, TN, 37115 |
| G11000110465 | SUNCREST OMNI | ACTIVE | 2011-11-14 | 2026-12-31 | No data | 901 HUGH WALLIS ROAD SOUTH, LAFAYETTE, LA, 70508 |
| G11000007417 | SUNCREST HOME HEALTH | EXPIRED | 2011-01-18 | 2016-12-31 | No data | 510 HOSPITAL DRIVE, SUITE 100, REGULATORY AFFAIRS, MADISON, TN, 37115 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-22 | 901 Hugh Wallis Road South, Lafayette, LA 70805 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-22 | 901 Hugh Wallis Road South, Lafayette, LA 70805 | No data |
| LC STMNT OF RA/RO CHG | 2023-11-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-11-16 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-11-16 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001582262 | TERMINATED | 1000000532489 | MONROE | 2013-09-16 | 2033-10-29 | $ 300.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| CORLCRACHG | 2023-11-16 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-05-01 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-25 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-04 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
