| Entity Name: | PHOENIX PRIMARY CARE, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Apr 2020 (5 years ago) |
| Document Number: | L20000109385 |
| FEI/EIN Number | 85-0962565 |
| Address: | 1108 S State Street, Bunnell, FL, 32110, US |
| Mail Address: | P.O. BOX 354925, PALM COAST, FL, 32135, US |
| ZIP code: | 32110 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508489790 | 2020-05-21 | 2020-05-21 | PO BOX 354925, PALM COAST, FL, 321354925, US | 26B OFFICE PARK DR, PALM COAST, FL, 321373808, US | |||||||||||||||
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| Phone | +1 386-597-2861 |
| Fax | 8442723971 |
Authorized person
| Name | MS. SANDRA SHANK |
| Role | CEO |
| Phone | 3865972861 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SHANK SANDRA | Agent | 1108 S State Street, Bunnell, FL, 32110 |
| Name | Role | Address |
|---|---|---|
| ABUNDANT LIFE MINISTRIES-HOPE HOUSE, INC. | Authorized Member | P.O. BOX 354925, PALM COAST, FL, 32135 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-06 | 1108 S State Street, 107, Bunnell, FL 32110 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-06 | 1108 S State Street, 107, Bunnell, FL 32110 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-02-16 |
| ANNUAL REPORT | 2021-04-12 |
| Florida Limited Liability | 2020-04-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
