| Entity Name: | PRISTINE HOMECARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Dec 2019 (5 years ago) |
| Document Number: | L19000300719 |
| FEI/EIN Number | 844007837 |
| Address: | 1320 N. Semoran Blvd., Orlando, FL, 32807, US |
| Mail Address: | 2655 E. Oakland Park Boulevard, Suite 5, Ft. Lauderdale, FL, 33306, US |
| ZIP code: | 32807 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992343255 | 2019-12-18 | 2023-05-11 | 624 EXECUTIVE PARK CT STE 1016A, STE 1016A, APOPKA, FL, 32703, US | 1320 N SEMORAN BLVD, SUITE 108, ORLANDO, FL, 32807, US | |||||||||||||||||||||
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| Phone | +1 215-490-5705 |
| Phone | +1 407-955-9483 |
Authorized person
| Name | MATEO MARTINEZ |
| Role | OWNER |
| Phone | 2154905705 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113083400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Martinez Mateo J | Agent | 2655 E. Oakland Park Boulevard, Ft. Lauderdale, FL, 33306 |
| Name | Role |
|---|---|
| LEVERAGE HEALTH III, INC. | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000094179 | MIND & MOBILITY | ACTIVE | 2021-07-19 | 2026-12-31 | No data | 2655 E. OAKLAND PARK BOULEVARD, SUITE 5, FT. LAUDERDALE, FL, 33306 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-26 | 1320 N. Semoran Blvd., #108, Orlando, FL 32807 | No data |
| CHANGE OF MAILING ADDRESS | 2021-06-01 | 1320 N. Semoran Blvd., #108, Orlando, FL 32807 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-06-01 | Martinez, Mateo J | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-06-01 | 2655 E. Oakland Park Boulevard, Suite 5, Ft. Lauderdale, FL 33306 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-26 |
| AMENDED ANNUAL REPORT | 2021-06-01 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-07-14 |
| Florida Limited Liability | 2019-12-10 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
