| Entity Name: | IMMACULATE ADULT DAY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Aug 2019 (6 years ago) |
| Document Number: | L19000195752 |
| FEI/EIN Number | 84-2633261 |
| Address: | 234 WILLARD ST., STE. A, COCOA, FL, 32922, US |
| Mail Address: | 234 WILLARD ST., STE. A, COCOA, FL, 32922, US |
| ZIP code: | 32922 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144876327 | 2019-08-14 | 2020-01-27 | 234 WILLARD ST STE A, COCOA, FL, 329227984, US | 234 WILLARD ST STE A, COCOA, FL, 329227984, US | |||||||||||||||||||||||||
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| Phone | +1 321-631-9014 |
| Fax | 3216318010 |
Authorized person
| Name | MS. JOY RUTHERFORD |
| Role | CEO |
| Phone | 3216319014 |
Taxonomy
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 311500000X - Alzheimer Center (Dementia Center) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105066100 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| IMMACULATE ADULT DAY CARE LLC 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 842633261 | 2024-06-13 | IMMACULATE ADULT DAY CARE LLC | 5 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-06-13 |
| Name of individual signing | EDWARD ROJAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RUTHERFORD JOY | Agent | 234 WILLARD ST., STE. A, COCOA, FL, 32922 |
| Name | Role | Address |
|---|---|---|
| RUTHERFORD JOY | Authorized Member | 234 WILLARD ST., STE. A, COCOA, FL, 32922 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000083867 | SENIOR CARE OF BREVARD | EXPIRED | 2019-08-09 | 2024-12-31 | No data | 234 WILLARD STREET STE A, COCOA, FL, 32922 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-08 | 234 WILLARD ST., STE. A, COCOA, FL 32922 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-04-14 |
| Florida Limited Liability | 2019-08-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
