| Entity Name: | ST. BERNADETTE'S CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 02 Sep 2011 (13 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | L11000101048 |
| FEI/EIN Number | 45-3192128 |
| Address: | 14489 Middle Fairway Drive, BROOKSVILLE, FL 34609 |
| Mail Address: | 14489 Middle Fairway Drive, BROOKSVILLE, FL 34609 |
| ZIP code: | 34609 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205119609 | 2011-09-21 | 2011-09-21 | PO BOX 15669, BROOKSVILLE, FL, 346040122, US | 5448 LEGEND HILLS LN, BROOKSVILLE, FL, 346099502, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 352-593-4242 |
Authorized person
| Name | JOSE CERON-FUENTES |
| Role | PRESIDENT |
| Phone | 3525934242 |
Taxonomy
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| License Number | ME95797 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2775247 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NULAND, CHRISTOPHER L | Agent | 1000 RIVERSIDE AVE, 115, JACKSONVILLE, FL 32204 |
| Name | Role | Address |
|---|---|---|
| CERON-FUENTES, JOSE D | Managing Member | 14489 Middle Fairway Drive, BROOKSVILLE, FL 34609 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-01-24 | 14489 Middle Fairway Drive, BROOKSVILLE, FL 34609 | No data |
| CHANGE OF MAILING ADDRESS | 2013-01-24 | 14489 Middle Fairway Drive, BROOKSVILLE, FL 34609 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-01-24 |
| ANNUAL REPORT | 2012-01-05 |
| Florida Limited Liability | 2011-09-02 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
