| Entity Name: | PROVIDENT CARE RESIDENTIAL HOME LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jun 2018 (7 years ago) |
| Document Number: | L18000156184 |
| FEI/EIN Number | 83-1168822 |
| Address: | 4170 MUTTER ROAD, SAINT CLOUD, FL, 34769 |
| Mail Address: | 4170 MUTTER ROAD, SAINT CLOUD, FL, 34769 |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578150397 | 2020-12-28 | 2020-12-28 | 4170 MUTTER RD, SAINT CLOUD, FL, 347696836, US | 4170 MUTTER RD, SAINT CLOUD, FL, 347696836, US | |||||||||||||||
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| Phone | +1 407-556-3406 |
| Fax | 4075563406 |
Authorized person
| Name | NADINE ELLIS-MCINTYRE |
| Role | ADMINISTRATOR |
| Phone | 3214435470 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ELLIS Nadine | Agent | 4170 MUTTER ROAD, ST. CLOUD, FL, 34769 |
| Name | Role | Address |
|---|---|---|
| Ellis Nadine | Manager | 4170 Mutter Rd, St. Cloud, FL, 34769 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000090080 | PROVIDENT HOUSE | ACTIVE | 2023-08-02 | 2028-12-31 | No data | 4170 MUTTER ROAD, SAINT CLOUD, FL, 34769 |
| G18000075380 | PROVIDENT HOUSE | EXPIRED | 2018-07-10 | 2023-12-31 | No data | 4170 MUTTER ROAD, SAINT CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-05-05 | ELLIS, Nadine | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-23 | 4170 MUTTER ROAD, ST. CLOUD, FL 34769 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-06-14 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-05-05 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-03-23 |
| ANNUAL REPORT | 2019-04-23 |
| Florida Limited Liability | 2018-06-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
