| Entity Name: | CUSTOMIZED CARE MANAGEMENT SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
CUSTOMIZED CARE MANAGEMENT SERVICES LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 20 Jan 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 27 Sep 2023 (2 years ago) |
| Document Number: | L15000010702 |
| FEI/EIN Number |
474730748
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4119 PARKER AVE, WEST PALM BEACH, FL, 33405, US |
| Mail Address: | 4119 PARKER AVE, WEST PALM BEACH, FL, 33405, US |
| ZIP code: | 33405 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215397989 | 2016-02-24 | 2021-06-12 | 4119 PARKER AVE, WEST PALM BEACH, FL, 334052507, US | 4121 PARKER AVE, WEST PALM BEACH, FL, 334052507, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-328-7527 |
| Phone | +1 561-460-2464 |
Authorized person
| Name | MRS. NERLYN JESTINE |
| Role | CEO |
| Phone | 5613287527 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| License Number | ARNP9227682 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017276500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JESTINE Tatianna g | Auth | 4119 PARKER AVE, WEST PALM BEACH, FL, 33405 |
| JESTINE Tatianna G | Agent | 4119 PARKER AVE, WEST PALM BEACH, FL, 33405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-05 | JESTINE, Tatianna G | - |
| REGISTERED AGENT ADDRESS CHANGED | 2023-09-27 | 4119 PARKER AVE, WEST PALM BEACH, FL 33405 | - |
| CHANGE OF MAILING ADDRESS | 2023-09-27 | 4119 PARKER AVE, WEST PALM BEACH, FL 33405 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2023-09-27 | 4119 PARKER AVE, WEST PALM BEACH, FL 33405 | - |
| REINSTATEMENT | 2023-09-27 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | - | - |
| REINSTATEMENT | 2021-11-18 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | - | - |
| REINSTATEMENT | 2020-12-08 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| REINSTATEMENT | 2023-09-27 |
| ANNUAL REPORT | 2022-04-29 |
| REINSTATEMENT | 2021-11-18 |
| REINSTATEMENT | 2020-12-08 |
| LC Name Change | 2019-11-12 |
| LC Name Change | 2019-04-17 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-24 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1542647302 | 2020-04-28 | 0455 | PPP | 3175 s congress ave, PALM SPRINGS, FL, 33461 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 May 2025
Sources: Florida Department of State
