| Entity Name: | TOTAL CARE MEDICINE, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Dec 2021 (3 years ago) |
| Date of dissolution: | 16 Jul 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 16 Jul 2022 (3 years ago) |
| Document Number: | L21000515390 |
| Address: | 1719 RYE RD E, BRADENTON, FL, 34212, US |
| Mail Address: | 1719 RYE RD E, BRADENTON, FL, 34212, US |
| ZIP code: | 34212 |
| County: | Manatee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164181145 | 2021-12-17 | 2021-12-17 | 11161 STATE ROAD 70 E UNIT 110-848, LAKEWOOD RANCH, FL, 342029407, US | 11161 STATE ROAD 70 E UNIT 110-848, LAKEWOOD RANCH, FL, 342029407, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 703-677-1035 |
Authorized person
| Name | MR. CORY W. LUCAS |
| Role | CEO |
| Phone | 7036771035 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1225299035 |
| State | MS |
| Issuer | MEDICAID |
| Number | 1790226942 |
| State | VA |
| Name | Role | Address |
|---|---|---|
| LUCAS CORY W | Agent | 1719 RYE RD E, BRADENTON, FL, 34212 |
| Name | Role | Address |
|---|---|---|
| TAHIRAJ GENTI | President | 3828 W PLATT ST, TAMPA, FL, 33609 |
| Name | Role | Address |
|---|---|---|
| LUCAS CORY W | Chief Executive Officer | 1719 RYE RD E., BRADENTON, FL, 34212 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-07-16 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-07-16 |
| Florida Limited Liability | 2021-12-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
