| Entity Name: | MIRACULOUS CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 May 2018 (7 years ago) |
| Document Number: | L18000121978 |
| FEI/EIN Number | 82-5507131 |
| Address: | 499 N State Road 434, Altamonte Springs, FL, 32714, US |
| Mail Address: | 499 N State Road 434, Altamonte Springs, FL, 32714, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356951719 | 2020-07-31 | 2023-08-25 | 4457 RIBBLESDALE LN, ORLANDO, FL, 328082031, US | 4457 RIBBLESDALE LN, ORLANDO, FL, 328082031, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-307-6822 |
Authorized person
| Name | BRENDA BAXTER |
| Role | PRESIDENT |
| Phone | 4073076822 |
Taxonomy
| Taxonomy Code | 163WH0200X - Home Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 374U00000X - Home Health Aide |
| Is Primary | No |
| Taxonomy Code | 385H00000X - Respite Care |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101683700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAXTER BRENDA | Agent | 4457 RIBBLESDALE LANE, ORLANDO, FL, 32808 |
| Name | Role | Address |
|---|---|---|
| BAXTER BRENDA | Chief Executive Officer | 4457 RIBBLESDALE LANE, ORLANDO, FL, 32808 |
| Name | Role | Address |
|---|---|---|
| REID IVYLIN | Chief Operating Officer | 4457 RIBBLESDALE LANE, ORLANDO, FL, 32808 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-04 | 499 N State Road 434, SUITE 2033, Altamonte Springs, FL 32714 | No data |
| CHANGE OF MAILING ADDRESS | 2022-11-04 | 499 N State Road 434, SUITE 2033, Altamonte Springs, FL 32714 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-14 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-03-15 |
| ANNUAL REPORT | 2019-05-01 |
| Florida Limited Liability | 2018-05-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
