| Entity Name: | PROFESSIONAL HEALTH CARE OF PINELLAS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Nov 2017 (7 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 28 Nov 2017 (7 years ago) |
| Document Number: | L17000243646 |
| FEI/EIN Number | 59-3440564 |
| Address: | 1839 CENTRAL AVE, ST PETERSBURG, FL, 33713, US |
| Mail Address: | 1839 CENTRAL AVE, ST PETERSBURG, FL, 33713, US |
| ZIP code: | 33713 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568970903 | 2018-01-19 | 2018-01-19 | 1839 CENTRAL AVE, ST PETERSBURG, FL, 337138900, US | 5500 9TH ST N, ST PETERSBURG, FL, 337031204, US | |||||||||||||||||||||
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| Phone | +1 727-820-1040 |
| Fax | 7278217213 |
| Phone | +1 727-525-5500 |
Authorized person
| Name | CLAUDIA J POULIN |
| Role | CREDENTIALING SPECIALIST |
| Phone | 7278201040 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PROFESSIONAL HEALTH CARE OF PINELLAS, LLC WELFARE BENEFIT PLAN | 2023 | 593440564 | 2024-06-18 | PROFESSIONAL HEALTH CARE OF PINELLAS, LLC | 160 | |||||||||||||||||||||||||||||||||
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| Active participants | 160 |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2022-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7272108401 |
| Plan sponsor’s mailing address | 1839 CENTRAL AVE, ST PETERSBURG, FL, 337138900 |
| Plan sponsor’s address | 1839 CENTRAL AVE, ST PETERSBURG, FL, 337138900 |
Number of participants as of the end of the plan year
| Active participants | 135 |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7273321054 |
| Plan sponsor’s address | 1839 CENTRAL AVENUE, SAINT PETERSBURG, FL, 33713 |
Signature of
| Role | Plan administrator |
| Date | 2019-06-06 |
| Name of individual signing | FADI SABA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-06-06 |
| Name of individual signing | FADI SABA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7273321054 |
| Plan sponsor’s address | 1839 CENTRAL AVENUE, SAINT PETERSBURG, FL, 33713 |
Signature of
| Role | Plan administrator |
| Date | 2018-10-05 |
| Name of individual signing | FADI SABA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2018-10-05 |
| Name of individual signing | FADI SABA |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SABA FADI MD | Agent | 1839 CENTRAL AVE, ST PETERSBURG, FL, 33713 |
| Name | Role | Address |
|---|---|---|
| SABA ABIGAIL | Manager | 1839 CENTRAL AVE, ST PETERSBURG, FL, 33713 |
| SABA FADI MD | Manager | 1839 CENTRAL AVE, ST PETERSBURG, FL, 33713 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000102403 | COMMUNITY CARE DIAGNOSTIC CLINIC | ACTIVE | 2024-08-28 | 2029-12-31 | No data | 1839 CENTRAL AVE, SAINT PETERSBURG, FL, 33713 |
| G24000102406 | PHC HEALTH AND WELLNESS | ACTIVE | 2024-08-28 | 2029-12-31 | No data | 1839 CENTRAL AVE, SAINT PETERSBURG, FL, 33713 |
| G19000020864 | VEIN INSTITUTE OF PINELLAS | ACTIVE | 2019-02-11 | 2029-12-31 | No data | 1839 CENTRAL AVENUE, SAINT PETERSBURG, FL, 33713 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2017-11-28 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P97000034820. CONVERSION NUMBER 700000176157 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-22 |
| ANNUAL REPORT | 2023-01-12 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-02-21 |
| Florida Limited Liability | 2017-11-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
