| Entity Name: | MY RESIDENCE CARE PLACE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 08 May 2017 (8 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L17000101536 |
| Address: | 10175 COUNTY ROAD 229, OXFORD, FL 34484 |
| Mail Address: | 10175 COUNTY ROAD 229, OXFORD, FL 34484 |
| ZIP code: | 34484 |
| County: | Sumter |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629582663 | 2017-11-29 | 2018-06-16 | 10175 COUNTY ROAD 229, OXFORD, FL, 344843955, US | 10175 COUNTY ROAD 229, OXFORD, FL, 344843955, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-484-5495 |
| Fax | 3523300621 |
Authorized person
| Name | KIM RICHELLE JONES |
| Role | OWNER |
| Phone | 3524845495 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 234865 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017159100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JONES, KIM R | Agent | 10175 COUNTY ROAD 229, OXFORD, FL 34484 |
| Name | Role | Address |
|---|---|---|
| JONES, KIM R | Manager | 10175 COUNTY ROAD 229, OXFORD, FL 34484 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2017-05-08 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
