| Entity Name: | SAMARA HOME DOCTOR SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Jul 2018 (7 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Sep 2020 (4 years ago) |
| Document Number: | L18000181359 |
| FEI/EIN Number | 83-1644195 |
| Address: | 1800 Pembrook Dr., Suite 300, Orlando, FL 32810 |
| Mail Address: | 1800 Pembrook Dr., Suite 300, Orlando, FL 32810 |
| ZIP code: | 32810 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144704073 | 2018-09-17 | 2020-06-04 | 1800 PEMBROOK DR STE 300, ORLANDO, FL, 328106378, US | 1800 PEMBROOK DR STE 300, ORLANDO, FL, 328106378, US | |||||||||||||||||||||
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| Phone | +1 321-200-4489 |
| Fax | 4075545860 |
Authorized person
| Name | DR. JUDITH FAUSTIN |
| Role | MEDICAL DIRECTOR |
| Phone | 3212004489 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | LB425 |
| State | FL |
| Name | Role |
|---|---|
| SAMARA HOME DOCTOR SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| FAUSTIN, JUDITH, Dr. | MEDICAL DIRECTOR | 1800 Pembrook Dr., Suite 300 Orlando, FL 32810 |
| Name | Role | Address |
|---|---|---|
| gabriel, frantz | Manager | 1800 Pembrook Drive, Orlando, FL 32810 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000108703 | DOCTOR TO YOUR DOOR OF CENTRAL FLORIDA, LLC | EXPIRED | 2018-10-04 | 2023-12-31 | No data | 1039 ROCK CREEK ST, APOPKA, FL, 32712 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2020-10-05 | Samara Home Doctor Services, LLC | No data |
| REINSTATEMENT | 2020-09-30 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-09-30 | 1800 Pembrook Dr., Suite 300, Orlando, FL 32810 | No data |
| CHANGE OF MAILING ADDRESS | 2020-09-30 | 1800 Pembrook Dr., Suite 300, Orlando, FL 32810 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-09-30 | 1800 Pembrook Dr., Suite 300, Orlando, FL 32810 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2020-01-27 | SAMARA HOME DOCTOR SERVICES, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-03-04 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-03-10 |
| AMENDED ANNUAL REPORT | 2020-10-05 |
| REINSTATEMENT | 2020-09-30 |
| LC Amendment and Name Change | 2020-01-27 |
| ANNUAL REPORT | 2019-04-15 |
| Florida Limited Liability | 2018-07-30 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
