| Entity Name: | LIGHTHOUSE HEALTH PLAN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 18 Oct 2017 (7 years ago) |
| Date of dissolution: | 21 Jun 2023 (2 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 21 Jun 2023 (2 years ago) |
| Document Number: | L17000216087 |
| FEI/EIN Number | 82-3182832 |
| Address: | 1717 North E Street, Suite 320, Pensacola, FL 32501 |
| Mail Address: | 1717 North E Street, Suite 320, Pensacola, FL 32501 |
| ZIP code: | 32501 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285109587 | 2018-10-12 | 2018-10-12 | 700 E GREGORY ST, PENSACOLA, FL, 325024142, US | 700 E GREGORY ST, PENSACOLA, FL, 325024142, US | |||||||||||||||||||||||||
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| Phone | +1 850-908-3001 |
Authorized person
| Name | SCOTT METHENY |
| Role | CFO |
| Phone | 8509083001 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1001225-02 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1001225-01 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CALLAHAN, ELIZABETH C | Agent | 1717 NORTH E STREET, SUITE 320, PENSACOLA, FL 32501 |
| Name | Role |
|---|---|
| EVOLENT HEALTH LLC | Manager |
| Name | Role | Address |
|---|---|---|
| Gleason, Michael | Chief Executive Officer | 1717 North E Street, Suite 320 Pensacola, FL 32501 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2023-06-21 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-25 | 1717 North E Street, Suite 320, Pensacola, FL 32501 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-16 | 1717 North E Street, Suite 320, Pensacola, FL 32501 | No data |
| LC AMENDMENT | 2017-11-01 | No data | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2023-06-21 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-03-12 |
| LC Amendment | 2017-11-01 |
| Florida Limited Liability | 2017-10-18 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
