| Entity Name: | PROVIDERS HEALTH ALLIANCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Jan 2015 (10 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 25 Sep 2023 (a year ago) |
| Document Number: | L15000013085 |
| FEI/EIN Number | 47-2865314 |
| Address: | C/O BELLA VIDA FAMILY PRACTICE, 11327 OKEECHOBEE BLVD, #2 & 3, ROYAL PALM BEACH, FL 33411 |
| Mail Address: | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD, STE 10A-413, WELLINGTON, FL 33414 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689064834 | 2015-01-27 | 2020-09-09 | 11924 FOREST HILL BLVD STE 10A-138, WELLINGTON, FL, 334146256, US | 12955 PALMS WEST DR STE 203, LOXAHATCHEE, FL, 334709217, US | |||||||||||||||||||
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| Phone | +1 561-293-4301 |
| Fax | 5618283111 |
| Phone | +1 561-231-5200 |
| Fax | 5612315201 |
Authorized person
| Name | MRS. TINA DOCHNIAK |
| Role | PRESIDENT |
| Phone | 5612934305 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PROVIDERS HEALTH ALLIANCE 401(K) PLAN | 2023 | 472865314 | 2024-10-02 | PROVIDERS HEALTH ALLIANCE, LLC | 27 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-02 |
| Name of individual signing | ALLISON BRECHER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 5615064935 |
| Plan sponsor’s address | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-31 |
| Name of individual signing | CHERYL ANDERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 5612934304 |
| Plan sponsor’s address | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
Signature of
| Role | Plan administrator |
| Date | 2022-09-26 |
| Name of individual signing | CHERYL ANDERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 5615064935 |
| Plan sponsor’s address | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 5615064935 |
| Plan sponsor’s address | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2018-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 5615064935 |
| Plan sponsor’s address | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| ANDERS, CHERYL | Agent | C/O THINK BIG HEALTH CARE SOLUTIONS, LLC, 11924 FOREST HILL BOULEVARD, STE 10A-138, WELLINGTON, FL 33414 |
| Name | Role | Address |
|---|---|---|
| DOCHNIAK, TINA M, DNP, ARNP | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| ROSA, MELISSA MORA, DO | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| Aleman Chinea, Ricardo | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| Reyes , Anita | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| MADZEWA, FELISTAS | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| Schneider, Lisa | Authorized Member | PROVIDERS HEALTH ALLIANCE, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| MILOSCIA, JOHN, MD | Authorized Member | 11924 FOREST HILL BLVD STE 10A 413, WELLINGTON, FL 33414 |
| ACLOQUE, JUDE, MD | Authorized Member | 11924 FOREST HILL BOULEVARD, STE 10- 413 WELLINGTON, FL 33414 |
| Name | Role | Address |
|---|---|---|
| ANDERS, CHERYL MENDELSOHN | Manager | C/O THINK BIG HEALTH CARE SOLUTIONS, LLC, 11924 FOREST HILL BOULEVARD STE 10A-413 WELLINGTON, FL 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2023-09-25 | No data | No data |
| LC AMENDMENT | 2022-08-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-14 | C/O BELLA VIDA FAMILY PRACTICE, 11327 OKEECHOBEE BLVD, #2 & 3, ROYAL PALM BEACH, FL 33411 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-04-12 | C/O THINK BIG HEALTH CARE SOLUTIONS, LLC, 11924 FOREST HILL BOULEVARD, STE 10A-138, WELLINGTON, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-12 | C/O BELLA VIDA FAMILY PRACTICE, 11327 OKEECHOBEE BLVD, #2 & 3, ROYAL PALM BEACH, FL 33411 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-08-23 | ANDERS, CHERYL | No data |
| LC STMNT OF RA/RO CHG | 2019-08-23 | No data | No data |
| LC AMENDMENT | 2018-05-21 | No data | No data |
| LC AMENDMENT | 2016-06-13 | No data | No data |
| LC AMENDMENT | 2016-01-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| LC Amendment | 2023-09-25 |
| ANNUAL REPORT | 2023-03-27 |
| LC Amendment | 2022-08-15 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-04-07 |
| AMENDED ANNUAL REPORT | 2020-05-09 |
| ANNUAL REPORT | 2020-04-12 |
| CORLCRACHG | 2019-08-23 |
| ANNUAL REPORT | 2019-04-29 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
