| Entity Name: | CITRUS PREFERRED CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Jul 2020 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 27 Jul 2020 (4 years ago) |
| Document Number: | L20000191646 |
| FEI/EIN Number | 85-1997192 |
| Address: | 2525 Highway 44 W, Inverness, FL 34453 |
| Mail Address: | 81 WEST ALBANY LANE, HERNANDO, FL 34442 |
| ZIP code: | 34453 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750976874 | 2021-03-02 | 2021-03-02 | 81 W ALBANY LN, HERNANDO, FL, 344428279, US | 81 W ALBANY LN, HERNANDO, FL, 344428279, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 301-556-8681 |
Authorized person
| Name | DR. LOUIS B BOIS |
| Role | MEDICAL DOCTOR |
| Phone | 3015568681 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008814900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 014444800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLAUDEL BOIS , LOUIS BERNADIN | Agent | 81 WEST ALBANY LN, HERNANDO, FL 34442 |
| Name | Role | Address |
|---|---|---|
| CLAUDEL BOIS, LOUIS BERNADIN | Authorized Member | 81 WEST ALBANY LANE, HERNANDO, FL 34442 |
| DESAMOUR, JOSENIE | Authorized Member | 81 WEST ALBANY LN, HERNANDO, FL 34442 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-01-11 | CLAUDEL BOIS , LOUIS BERNADIN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-11 | 81 WEST ALBANY LN, HERNANDO, FL 34442 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-11 | 2525 Highway 44 W, Inverness, FL 34453 | No data |
| LC AMENDMENT | 2020-07-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-07-27 | 2525 Highway 44 W, Inverness, FL 34453 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-11 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-24 |
| LC Amendment | 2020-07-27 |
| Florida Limited Liability | 2020-07-06 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
