| Entity Name: | PROVIDENCE HOMECARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Dec 2016 (8 years ago) |
| Document Number: | L16000218496 |
| FEI/EIN Number | 81-4914750 |
| Address: | 10250 SW 56 STREET, MIAMI, FL, 33165, US |
| Mail Address: | 10250 SW 56 STREET,, MIAMI, FL, 33165, US |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043896905 | 2021-03-22 | 2021-03-22 | 10250 SW 56TH ST STE D101, MIAMI, FL, 331657065, US | 10250 SW 56TH ST STE D101, MIAMI, FL, 331657065, US | |||||||||||||||||||
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| Phone | +1 305-220-1088 |
Authorized person
| Name | NERCY B RADCLIFFE |
| Role | ADMINISTRATOR |
| Phone | 3052201088 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102544500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RADCLIFFE NERCY B | Agent | 10250 SW 56 ST, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| RADCLIFFE NERCY | Authorized Member | 10250 SW 56 ST, Miami, FL, 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-10 | 10250 SW 56 STREET, SUITE D-101, MIAMI, FL 33165 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-03-15 | 10250 SW 56 ST, SUITE D103, MIAMI, FL 33165 | No data |
| CHANGE OF MAILING ADDRESS | 2017-12-21 | 10250 SW 56 STREET, SUITE D-101, MIAMI, FL 33165 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-03-15 |
| Florida Limited Liability | 2016-12-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
