| Entity Name: | LEGACY HEALTHCARE CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
LEGACY HEALTHCARE CENTER LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 29 Sep 2021 (4 years ago) |
| Document Number: | L21000428618 |
| FEI/EIN Number |
87-2874201
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 105 NW 33rd, GAINESVILLE, FL, 32607, US |
| Mail Address: | 113 WOODLAND LANE, HAWTHORNE, FL, 32640 |
| ZIP code: | 32607 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194488973 | 2021-10-18 | 2022-02-10 | 113 WOODLAND LN, HAWTHORNE, FL, 326406343, US | 3620 NW 43RD ST STE A-C, GAINESVILLE, FL, 326068103, US | |||||||||||||||||||||
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| Phone | +1 325-575-9991 |
| Fax | 6014299159 |
Authorized person
| Name | VALOREA WILLIAMS |
| Role | APRN |
| Phone | 3522565933 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 107662400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILLIAMS VALOREA | Auth | 113 WOODLAND LANE, HAWTHORNE, FL, 32640 |
| WILLIAMS VALOREA | Agent | 113 WOODLAND LANE, HAWTHORNE, FL, 32640 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-18 | 105 NW 33rd, SUITE B, GAINESVILLE, FL 32607 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-14 |
| Florida Limited Liability | 2021-09-29 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
