| Entity Name: | ALLCARE OF SOUTHWEST FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Aug 2017 (7 years ago) |
| Document Number: | L17000169377 |
| FEI/EIN Number | 82-2658840 |
| Address: | 3616 BROADWAY AVE, FORT MYERS, FL 33901 |
| Mail Address: | 3616 BROADWAY AVE, FORT MYERS, FL 33901 |
| ZIP code: | 33901 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598246076 | 2018-08-23 | 2018-08-23 | 2040 VIRGINIA AVE, FORT MYERS, FL, 339013313, US | 2040 VIRGINIA AVE, FORT MYERS, FL, 339013313, US | |||||||||||||||||||||
|
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| Phone | +1 800-674-3729 |
Authorized person
| Name | LATONIA SMITH |
| Role | OFFICE MANAGER |
| Phone | 8006743729 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 023093100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOLLY, ROGER E | Agent | 3616 Broadway, FORT MYERS, FL 33901 |
| Name | Role | Address |
|---|---|---|
| Lolly, Roger E | Manager | 3616 Broadway, FORT MYERS, FL 33901 |
| Lolly, Roger J | Manager | 3616 Broadway, FORT MYERS, FL 33901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000074480 | ALLCARE NATIONAL | EXPIRED | 2018-07-06 | 2023-12-31 | No data | 2040 VIRGINIA AVE, FORT MYERS, FL, 33901 |
| G18000074482 | CARECREW | EXPIRED | 2018-07-06 | 2023-12-31 | No data | 2040 VIRGINIA AVE, FORT MYERS, FL, 33901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-06 | 3616 Broadway, FORT MYERS, FL 33901 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-27 | 3616 BROADWAY AVE, FORT MYERS, FL 33901 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-27 | 3616 BROADWAY AVE, FORT MYERS, FL 33901 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-09-22 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-04-30 |
| Florida Limited Liability | 2017-08-08 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
