| Entity Name: | PROVIDER SERVICES OF AMERICA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Feb 2014 (11 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L14000028876 |
| FEI/EIN Number | 46-4866276 |
| Mail Address: | 2385 NW Executive Center Drive, Suite 100, BOCA RATON, FL, 33431, US |
| Address: | 2385 NE Executive Center Drive, BOCA RATON, FL, 33431, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689022147 | 2016-05-25 | 2016-05-26 | PO BOX 812140, BOCA RATON, FL, 334812140, US | 2385 NW EXECUTIVE CENTER DR, SUITE 100, BOCA RATON, FL, 334318579, US | |||||||||||||||||||||
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| Phone | +1 561-463-8102 |
| Fax | 5613312707 |
Authorized person
| Name | HARRISON ZIPPER |
| Role | OWNER |
| Phone | 5614638102 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CITY TAX RECEIPT |
| Number | 16-00063751 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Zipper Harrison | Agent | 2385 NW Executive Center Drive, BOCA RATON, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| TICHNER MAC S | Manager | 2385 NW Executive Center Drive, BOCA RATON, FL, 33431 |
| Zipper Harrison | Manager | 2385 NW Executive Center Drive, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-09-10 | 2385 NE Executive Center Drive, Suite 100, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-09-10 | 2385 NW Executive Center Drive, Suite 100, BOCA RATON, FL 33431 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-05-20 | 2385 NE Executive Center Drive, Suite 100, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-01-25 | Zipper, Harrison | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-15 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-09-10 |
| ANNUAL REPORT | 2019-05-20 |
| ANNUAL REPORT | 2018-01-25 |
| ANNUAL REPORT | 2017-04-05 |
| AMENDED ANNUAL REPORT | 2016-05-19 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-01-13 |
| Florida Limited Liability | 2014-02-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
