| Entity Name: | FULTON HOME CARE SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Sep 2017 (7 years ago) |
| Document Number: | L17000188128 |
| FEI/EIN Number | 82-2803746 |
| Address: | 10300 49th Street north, Clearwater, FL, 33762, US |
| Mail Address: | 10300 49th Street north, Clearwater, FL, 33762, US |
| ZIP code: | 33762 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588220073 | 2019-05-10 | 2019-05-10 | 2308 FULTON WAY, LARGO, FL, 337741517, US | 2308 FULTON WAY, LARGO, FL, 337741517, US | |||||||||||||||||||
|
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| Phone | +1 727-565-9029 |
Authorized person
| Name | MRS. BERTISHIA LASHANTI MOSLEY |
| Role | CHIEF OF OPERATIONS |
| Phone | 7275659029 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022971400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MOSLEY BERTISHIA L | Agent | 10300 49th Street north, Clearwater, FL, 33762 |
| Name | Role | Address |
|---|---|---|
| MOSlEY BERTISHIA L | Authorized Representative | 10300 49th Street north, Clearwater, FL, 33762 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-24 | 10300 49th Street north, Suite 121, Clearwater, FL 33762 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-24 | 10300 49th Street north, Suite 121, Clearwater, FL 33762 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-19 | 10300 49th Street north, Suite 121, Clearwater, FL 33762 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-01-24 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-03-19 |
| ANNUAL REPORT | 2018-09-20 |
| Florida Limited Liability | 2017-09-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
