| Entity Name: | PROVIDENTIAL HEALTH SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Nov 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Oct 2023 (a year ago) |
| Document Number: | L19000274737 |
| FEI/EIN Number | 84-3756199 |
| Address: | 4849 Lake Worth Road, SUITE 200, GREENACRES, FL, 33463, US |
| Mail Address: | 4849 LAKE WORTH ROAD, SUITE 200, GREENACRES, FL, 33463, US |
| ZIP code: | 33463 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033755327 | 2019-11-21 | 2019-11-21 | 200 KNUTH RD STE 212B, BOYNTON BEACH, FL, 334364636, US | 200 KNUTH RD STE 212B, BOYNTON BEACH, FL, 334364636, US | |||||||||||||||||
|
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| Phone | +1 561-460-1717 |
Authorized person
| Name | ALEXANDRA DUFORT |
| Role | SECRETARY |
| Phone | 5617073030 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| PIERRE LEMUEL | Agent | 10842 BLUE PALM STREET, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| PIERRE LEMUEL | Manager | 10842 BLUE PALM STREET, PLANTATION, FL, 33324 |
| DUFORT ALEXANDRA | Manager | 5541 HAVEFORD WAY, LAKE WORTH, FL, 33463 |
| DORANTE NILA | Manager | 6219 ADRIATIC WAY, WEST PALM BEACH, FL, 33413 |
| Name | Role | Address |
|---|---|---|
| Campbell-Robinson Rhoenna E | Auth | 4849 LAKE WORTH ROAD, GREENACRES, FL, 33463 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-10 | 4849 Lake Worth Road, SUITE 200, GREENACRES, FL 33463 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-12 | 4849 Lake Worth Road, SUITE 200, GREENACRES, FL 33463 | No data |
| REINSTATEMENT | 2023-10-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-17 | PIERRE, LEMUEL | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-12 |
| REINSTATEMENT | 2023-10-17 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-03-30 |
| ANNUAL REPORT | 2020-06-12 |
| Florida Limited Liability | 2019-11-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
