| Entity Name: | GRACE CARE SER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Apr 2016 (9 years ago) |
| Document Number: | L16000069721 |
| FEI/EIN Number | 81-2136014 |
| Address: | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 |
| Mail Address: | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 |
| ZIP code: | 33880 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619331451 | 2016-04-07 | 2023-06-29 | 395 E CENTRAL AVE, WINTER HAVEN, FL, 338803047, US | 395 E CENTRAL AVE, WINTER HAVEN, FL, 338803047, US | |||||||||||||||||||||||||
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| Phone | +1 863-585-0147 |
| Fax | 8638755348 |
Authorized person
| Name | SHANELL S CODY |
| Role | OWNER |
| Phone | 8635850147 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017257100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CODY, SHANELL | Agent | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 |
| Name | Role | Address |
|---|---|---|
| CODY, SHANELL | Authorized Representative | 4130 Country Club Rd S, WINTER HAVEN, FL 33881 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-07 | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-07 | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-07 | 395 E CENTRAL AVE, WINTER HAVEN, FL 33880 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-08-14 |
| ANNUAL REPORT | 2020-07-20 |
| ANNUAL REPORT | 2019-01-21 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-02-11 |
| Florida Limited Liability | 2016-04-07 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
