| Entity Name: | MERRICK NURSE REGISTRY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Mar 2016 (9 years ago) |
| Document Number: | L16000056013 |
| FEI/EIN Number | 81-1977671 |
| Address: | 8461 LAKE WORTH ROAD, LAKE WORTH, FL, 33467, US |
| Mail Address: | 8461 LAKE WORTH ROAD, SUITE 1-147, LAKE WORTH, FL, 33467, US |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871071944 | 2018-08-01 | 2019-04-22 | 840 SW 81ST AVE, SUITE 302 M, NORTH LAUDERDALE, FL, 33068, US | 8461 LAKE WORTH RD STE 1-133, LAKE WORTH, FL, 334672474, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 561-713-1123 |
| Fax | 5617131124 |
Authorized person
| Name | MRS. JANET BELL |
| Role | ADMINISTRATOR |
| Phone | 5617131123 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 30211985 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102407600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 018729000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHAN PHYLLIS | Agent | 8461 LAKE WORTH ROAD, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| KHAN PHYLLIS | Authorized Member | 8461 LAKE WORTH ROAD, LAKE WORTH, FL, 33467 |
| BELL JANET | Authorized Member | 8461 LAKE WORTH ROAD, LAKE WORTH, FL, 33467 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000010077 | MERRICK NURSE REGISTRY | ACTIVE | 2016-01-27 | 2026-12-31 | No data | 8461 LAKE WORTH RD, SUITE 1-147, LAKE WORTH, FL, 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-11-03 | 8461 LAKE WORTH ROAD, suite 1-147, LAKE WORTH, FL 33467 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-11-03 | 8461 LAKE WORTH ROAD, SUITE 1-147, LAKE WORTH, FL 33467 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-09-01 | 8461 LAKE WORTH ROAD, suite 1-147, LAKE WORTH, FL 33467 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-29 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-08 |
| AMENDED ANNUAL REPORT | 2020-11-03 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-18 |
| Florida Limited Liability | 2016-03-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
