| Entity Name: | CHRIS AND ELZA HEALTHCARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Dec 2020 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 13 May 2024 (9 months ago) |
| Document Number: | L20000374033 |
| FEI/EIN Number | 85-4211005 |
| Address: | 1665 Dr Martin Luther King Jr Blvd, Riviera, FL, 33407, US |
| Mail Address: | 12327 85th Rd N, WPB, FL, 33412, US |
| ZIP code: | 33407 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336738608 | 2021-01-12 | 2021-10-11 | 4889 LAKE WORTH RD STE 109, GREENACRES, FL, 334633480, US | 4889 LAKE WORTH RD STE 109, GREENACRES, FL, 334633480, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 561-801-0664 |
| Phone | +1 561-720-2443 |
| Fax | 5618775042 |
Authorized person
| Name | CAROLE JENKINS |
| Role | OWNER |
| Phone | 5618010664 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110363200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JENKINS CAROLE | Agent | 12327 85th Rd N, WPB, FL, 33412 |
| Name | Role | Address |
|---|---|---|
| Jenkins Carole | Owne | 12327 85th Rd N, WPB, FL, 33412 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2024-05-13 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-13 | 1665 Dr Martin Luther King Jr Blvd, Riviera, FL 33407 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-13 | 1665 Dr Martin Luther King Jr Blvd, Riviera, FL 33407 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-05-13 | JENKINS, CAROLE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-13 | 12327 85th Rd N, WPB, FL 33412 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000143451 | ACTIVE | 1000000981195 | PALM BEACH | 2024-02-26 | 2034-03-13 | $ 1,467.90 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, WEST PALM BEACH SERVICE CENTER, 2468 METROCENTRE BLVD, WEST PALM BEACH FL334073105 |
| Name | Date |
|---|---|
| REINSTATEMENT | 2024-05-13 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-04-16 |
| Florida Limited Liability | 2020-12-08 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
