| Entity Name: | DURRANCE MEDICAID PROVIDERS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 28 Feb 2019 (6 years ago) |
| Document Number: | L19000058577 |
| FEI/EIN Number | 84-1807706 |
| Address: | 9257 SW 137 ST, STARKE, FL 32091 |
| Mail Address: | 9257 SW 137 ST, STARKE, FL 32091 |
| ZIP code: | 32091 |
| County: | Bradford |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265199434 | 2021-11-23 | 2021-11-23 | 9257 SW 137TH ST, STARKE, FL, 320915974, US | 9257 SW 137TH ST, STARKE, FL, 320915974, US | |||||||||||||||||||
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| Phone | +1 904-226-5719 |
Authorized person
| Name | JEFFREY DURRANCE |
| Role | OWNER |
| Phone | 9042265719 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0043554 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DURRANCE, JEFFREY E | Agent | 9257 SW137TH ST, STARKE, FL 32091 |
| Name | Role | Address |
|---|---|---|
| DURRANCE, Jeffrey E | Manager | 9257 SW 137 ST, STARKE, FL 32091 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-10 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-04-07 |
| Florida Limited Liability | 2019-02-28 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
