| Entity Name: | EXCELSIOR COMMUNITY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 30 Nov 2015 (9 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | L15000199381 |
| FEI/EIN Number | 47-5617805 |
| Address: | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 |
| Mail Address: | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 |
| ZIP code: | 32216 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962877530 | 2015-12-08 | 2017-11-15 | 101 CENTURY 21 DR, STE 109B, JACKSONVILLE, FL, 322168115, US | 101 CENTURY 21 DR, STE 109B, JACKSONVILLE, FL, 322168115, US | |||||||||||||||||||
|
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| Phone | +1 904-619-1972 |
Authorized person
| Name | DEBORAH ANN MCKENZIE |
| Role | OWNER/CEO |
| Phone | 9045595975 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016492600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, DEBORAH | Agent | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 |
| Name | Role | Address |
|---|---|---|
| MCKENZIE, DEBORAH | Chief Executive Officer | 101 CENTURY 21 DRIVE, SUITE 205 JACKSONVILLE, FL 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-30 | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-30 | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-30 | 101 CENTURY 21 DRIVE, SUITE 205, JACKSONVILLE, FL 32216 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-18 | MCKENZIE, DEBORAH | No data |
| REINSTATEMENT | 2016-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-24 |
| REINSTATEMENT | 2016-10-18 |
| Florida Limited Liability | 2015-11-30 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
