| Entity Name: | MEDERI PRIVATE CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Apr 2019 (6 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 16 Nov 2023 (a year ago) |
| Document Number: | L19000092808 |
| FEI/EIN Number | 83-4371904 |
| Address: | 901 HUGH WALLIS RD S, LAFAYETTE, LA 70508 |
| Mail Address: | 901 HUGH WALLIS RD S, LAFAYETTE, LA 70508 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457910648 | 2019-06-11 | 2024-09-13 | PO BOX 51266, LAFAYETTE, LA, 705051266, US | 2815 NW 13TH ST STE 322, GAINESVILLE, FL, 326092879, US | |||||||||||||||||||||||||||||
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| Phone | +1 337-233-1307 |
| Fax | 3372335764 |
| Phone | +1 352-554-8023 |
| Fax | 3525548024 |
Authorized person
| Name | JOSHUA L. PROFFITT |
| Role | PRESIDENT |
| Phone | 3372331307 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104943900 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| LHC GROUP, INC. | Manager | No data |
| Proffitt, Joshua L. | Manager | 901 HUGH WALLIS RD S, LAFAYETTE, LA 70508 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000020877 | MEDERI PRIVATE CARE | ACTIVE | 2024-02-07 | 2029-12-31 | No data | 901 HUGH WALLIS ROAD SOUTH, LAFAYETTE, LA, 70508 |
| G19000093718 | MEDERI PRIVATE CARE | EXPIRED | 2019-08-27 | 2024-12-31 | No data | 901 HUGH WALLIS RD SOUTH, LAFAYETTE, LA, 70508 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2023-11-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-11-16 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-11-16 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2024-04-17 |
| CORLCRACHG | 2023-11-16 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-28 |
| ANNUAL REPORT | 2020-05-01 |
| Florida Limited Liability | 2019-04-08 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
