| Entity Name: | C AND C SHELTER CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Sep 2016 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 19 Oct 2018 (6 years ago) |
| Document Number: | L16000166877 |
| FEI/EIN Number | 82-0832438 |
| Address: | 7414 Irving Scott Drive, Jacksonville, FL 32209 |
| Mail Address: | 7414 Irving Scott Drive, Jacksonville, FL 32209 |
| ZIP code: | 32209 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629712013 | 2022-04-22 | 2022-04-22 | 7414 IRVING SCOTT DR, JACKSONVILLE, FL, 322091029, US | 2268 PLACEDA ST, JACKSONVILLE, FL, 322096968, US | |||||||||||||||||||||
|
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| Phone | +1 904-673-7212 |
| Fax | 9042120253 |
Authorized person
| Name | COLLETTE KATRELL HOLMES |
| Role | ADMINISTRATOR/OWNER |
| Phone | 9046737212 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015058700 |
| State | FL |
| Name | Role |
|---|---|
| C AND C SHELTER CARE LLC | Agent |
| Name | Role | Address |
|---|---|---|
| Holmes, Collette K | Administrator | 7414 Irving Scott Drive, Jacksonville, FL 32209 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-06-18 | 7414 Irving Scott Drive, Jacksonville, FL 32209 | No data |
| REINSTATEMENT | 2018-10-19 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-19 | C and C Shelter Care LLC | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-26 | 7414 Irving Scott Drive, Jacksonville, FL 32209 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-17 |
| ANNUAL REPORT | 2021-04-23 |
| ANNUAL REPORT | 2020-06-18 |
| ANNUAL REPORT | 2019-02-21 |
| REINSTATEMENT | 2018-10-19 |
| ANNUAL REPORT | 2017-04-26 |
| Florida Limited Liability | 2016-09-07 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
