| Entity Name: | HOMETOWN HEALTHCARE AND PEDIATRICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Aug 2021 (3 years ago) |
| Document Number: | L21000369346 |
| FEI/EIN Number | 87-4597858 |
| Address: | 315 N MAIN ST, TRENTON, FL 32693 |
| Mail Address: | 22856 SW 46TH AVE, NEWBERRY, FL 32669 |
| ZIP code: | 32693 |
| County: | Gilchrist |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235877697 | 2022-05-25 | 2023-01-06 | 22856 SW 46TH AVE, NEWBERRY, FL, 326694713, US | 315 N MAIN ST, TRENTON, FL, 326933462, US | |||||||||||||||||||||
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| Phone | +1 352-246-8566 |
| Fax | 7343220384 |
Authorized person
| Name | KRISTEN WELCH |
| Role | OFFICE MANAGER |
| Phone | 3522468566 |
Taxonomy
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116287400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COLEMAN, JOSHUA | Agent | 22856 SW 46TH AVE, NEWBERRY, FL 32669 |
| Name | Role | Address |
|---|---|---|
| COLEMAN, MICHELE | Authorized Representative | 22856 SW 46TH AVE, NEWBERRY, FL 32669 |
| COLEMAN, JOSHUA | Authorized Representative | 22856 SW 46TH AVE, NEWBERRY, FL 32669 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-19 | 315 N MAIN ST, TRENTON, FL 32693 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-04-07 |
| Florida Limited Liability | 2021-08-17 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
