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  5. GENESIS FAMILY PRACTICE LLC

GENESIS FAMILY PRACTICE LLC - Florida Company Profile

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Company Details

Entity Name: GENESIS FAMILY PRACTICE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 24 Sep 2012 (13 years ago)
Document Number: L12000121864
FEI/EIN Number 46-1045369
Address: 1133 SAXON BLVD, ORANGE CITY, FL, 32763
Mail Address: 1133 SAXON BLVD, ORANGE CITY, FL, 32763
ZIP code: 32763
City: Orange City
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
CHANMUGAM JAY MGN 1133 SAXON BLVD, ORANGE CITY, FL, 32763
CHANMUGAM JAY Agent 1133 SAXON BLVD, ORANGE CITY, FL, 32763

National Provider Identifier

NPI Number:
1447799242
Certification Date:
2022-11-28
Link:
View on NPI website

Authorized Person:

Name:
JAY C CHANMUGAM
Role:
OWNER
Phone:
3862182353

Taxonomy:

Selected Taxonomy:
208D00000X - General Practice Physician
Is Primary:
Yes

Contacts:

Phone:
+1 386-218-2353
Fax:
3862289701
Phone:
+1 386-676-9300
Fax:
3866769050

Form 5500 Series

Employer Identification Number (EIN):
461045369
Plan Year:
2019
Number Of Participants:
41
Sponsors Telephone Number:
4073147539
File:
View File
Plan Year:
2018
Number Of Participants:
20
Sponsors Telephone Number:
4073147539
File:
View File
Plan Year:
2017
Number Of Participants:
14
Sponsors Telephone Number:
3867479097
File:
View File
Plan Year:
2016
Number Of Participants:
1
Sponsors Telephone Number:
3867479097
File:
View File
Plan Year:
2016
Number Of Participants:
1
Sponsors Telephone Number:
3867479097

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G15000051757 HOME DOC'S EXPIRED 2015-05-27 2020-12-31 - 1133 SAXON BLVD, STE 200, ORANGE CITY, FL, 32713

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2021-01-13 1133 SAXON BLVD, ORANGE CITY, FL 32763 -

Documents

Name Date
ANNUAL REPORT 2025-02-07
ANNUAL REPORT 2024-02-07
ANNUAL REPORT 2023-02-02
ANNUAL REPORT 2022-02-24
ANNUAL REPORT 2021-01-13
ANNUAL REPORT 2020-03-24
ANNUAL REPORT 2019-03-06
ANNUAL REPORT 2018-04-30
ANNUAL REPORT 2017-03-31
ANNUAL REPORT 2016-04-29

USAspending Awards / Financial Assistance

Date:
2020-06-17
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO PROVIDE LOANS TO RESTORE AS NEARLY AS POSSIBLE THE VICTIMS OF ECONOMIC INJURY TYPE DISASTERS TO PRE-DISASTER CONDITIONS
Obligated Amount:
0.00
Face Value Of Loan:
150000.00
Total Face Value Of Loan:
150000.00
Date:
2020-05-01
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
10000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-05-01
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
ECONOMIC INJURY DISASTER GRANT
Obligated Amount:
10000.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-04-16
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
222500.00
Total Face Value Of Loan:
222500.00
Date:
2020-04-16
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
222500.00
Total Face Value Of Loan:
222500.00

Paycheck Protection Program

Jobs Reported:
15
Initial Approval Amount:
$222,500
Date Approved:
2020-04-16
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$222,500
Race:
American Indian or Alaska Native
Ethnicity:
Not Hispanic or Latino
Gender:
Male Owned
Veteran:
Non-Veteran
Forgiveness Amount:
$225,584.52
Servicing Lender:
Regions Bank
Use of Proceeds:
Payroll: $222,500

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1133 SAXON BLVD, ORANGE CITY, FL, 32763

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DOC AT HOME LLC, which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
DOC AT HOME LLC
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DOC AT HOME LLC, which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
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C & J SAXON ENTERPRISES, INC., which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
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C & J SAXON ENTERPRISES, INC., which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.

1133 SAXON BLVD, ORANGE CITY, FL, 32763

DOC AT HOME LLC
Florida Limited Liability Co.
DOC AT HOME LLC, which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
DOC AT HOME LLC
Florida Limited Liability Co.
DOC AT HOME LLC, which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
C & J SAXON ENTERPRISES, INC.
Domestic Profit
C & J SAXON ENTERPRISES, INC., which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.
C & J SAXON ENTERPRISES, INC.
Domestic Profit
C & J SAXON ENTERPRISES, INC., which currently Inactive, had registered address 1133 SAXON BLVD, ORANGE CITY, FL, 32763.

Date of last update: 02 Aug 2025

Sources: Florida Department of State

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