| Entity Name: | GENERATIONSPAN HEALTHCARE, L.L.C |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Jul 2012 (13 years ago) |
| Document Number: | L12000091237 |
| FEI/EIN Number | 26-4393452 |
| Mail Address: | 6271 WILLIAMS ROAD, TALLAHASSEE, FL, 32311, US |
| Address: | 1835 Buford Court, Tallahassee, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275963662 | 2013-11-21 | 2013-11-21 | 6271 WILLIAMS RD, TALLAHASSEE, FL, 323118526, US | 400 CAPITAL CIR SE STE 18128, TALLAHASSEE, FL, 323013802, US | |||||||||||||||||||||||
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| Phone | +1 850-264-9070 |
Authorized person
| Name | MS. FLORENCE PEDATIN BAMGBOSE |
| Role | CEO |
| Phone | 8502649070 |
Taxonomy
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| License Number | 3314182 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 305043200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAMGBOSE FLORENCE P | Agent | 6271 WILLIAMS ROAD, TALLAHASSEE, FL, 32311 |
| Name | Role | Address |
|---|---|---|
| BAMGBOSE FLORENCE P | Manager | 6271 WILLIAMS ROAD, TALLAHASSEE, FL, 32311 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000063680 | ANTICIPATE CONSULTANT | ACTIVE | 2023-05-22 | 2028-12-31 | No data | 6271 WILLIAMS ROAD, TALLAHASSEE, FL, 32311 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-03 | 1835 Buford Court, Tallahassee, FL 32308 | No data |
| CHANGE OF MAILING ADDRESS | 2020-05-03 | 1835 Buford Court, Tallahassee, FL 32308 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-05-03 | BAMGBOSE, FLORENCE P. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-03-22 | 6271 WILLIAMS ROAD, TALLAHASSEE, FL 32311 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-16 |
| ANNUAL REPORT | 2022-01-05 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-05-03 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-03-23 |
| ANNUAL REPORT | 2016-02-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
