| Entity Name: | SUNSHINE FAMILY HEALTHCARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Mar 2021 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 27 Nov 2023 (a year ago) |
| Document Number: | L21000101564 |
| FEI/EIN Number | 862129267 |
| Address: | 21 HOSPITAL DRIVE, SUITE 280, PALM COAST, FL, 32164, US |
| Mail Address: | 21 HOSPITAL DRIVE, SUITE 280, PALM COAST, FL, 32164, US |
| ZIP code: | 32164 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437744794 | 2021-03-08 | 2021-10-28 | 21 HOSPITAL DR STE 280, PALM COAST, FL, 321642456, US | 21 HOSPITAL DR STE 280, PALM COAST, FL, 321642456, US | |||||||||||||||||||||||
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| Phone | +1 386-313-6420 |
| Fax | 3863136433 |
| Phone | +1 386-986-6808 |
Authorized person
| Name | DR. JERRY D LEVENTHAL |
| Role | OWNER / PHYSICIAN |
| Phone | 3863136420 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 15598000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEVENTHAL SHARON | Agent | 21 HOSPITAL DRIVE, PALM COAST, FL, 32164 |
| Name | Role | Address |
|---|---|---|
| LEVENTHAL JERRY D | Manager | 21 HOSPITAL DRIVE, SUITE 280, PALM COAST, FL, 32164 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-11-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-02-25 | LEVENTHAL, SHARON | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| REINSTATEMENT | 2023-11-27 |
| ANNUAL REPORT | 2022-02-25 |
| Florida Limited Liability | 2021-03-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
