| Entity Name: | ATLANTIC IN-HOME CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Aug 2015 (9 years ago) |
| Document Number: | L15000145094 |
| FEI/EIN Number | 474919611 |
| Address: | 240 NW PEACOCK BLVD,, PORT ST. LUCIE, FL, 34986, US |
| Mail Address: | 240 NW PEACOCK BLVD,, PORT ST. LUCIE, FL, 34986-2274, US |
| ZIP code: | 34986 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548638216 | 2015-09-10 | 2022-07-19 | 240 NW PEACOCK BLVD STE 304, PORT ST LUCIE, FL, 349862274, US | 240 NW PEACOCK BLVD STE 304, PORT SAINT LUCIE, FL, 349862274, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 772-462-6707 |
| Fax | 7724636706 |
| Fax | 7724626706 |
Authorized person
| Name | GARY EVANS |
| Role | CFO |
| Phone | 7724626707 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | NR30211036 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016181800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| EVANS GARY W | Agent | 240 NW PEACOCK BLVD,, PORT ST. LUCIE, FL, 34986 |
| Name | Role | Address |
|---|---|---|
| EVANS GARY W | Authorized Person | 240 NW PEACOCK BLVD,, PORT ST. LUCIE, FL, 349862274 |
| Name | Role | Address |
|---|---|---|
| Johnson Kerri C | Manager | 240 NW Peacock Blvd, Port St Lucie, FL, 34986 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-01 | 240 NW PEACOCK BLVD,, SUITE 304, PORT ST. LUCIE, FL 34986 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-11 | 240 NW PEACOCK BLVD,, SUITE 304, PORT ST. LUCIE, FL 34986 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-11 | 240 NW PEACOCK BLVD,, SUITE 304, PORT ST. LUCIE, FL 34986 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-05 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-02-06 |
| ANNUAL REPORT | 2021-02-12 |
| ANNUAL REPORT | 2020-02-15 |
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-03-11 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-04-18 |
| Florida Limited Liability | 2015-08-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
