| Entity Name: | HOMEBOUND PATIENT MEDICAL PROVIDER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 Feb 2022 (3 years ago) |
| Document Number: | L22000058284 |
| FEI/EIN Number | 87-4499881 |
| Address: | 4706 NW 99TH AVE, SUNRISE, FL 33351, SUNRISE, FL 33351 |
| Mail Address: | 4706 NW 99TH AVE, SUNRISE, FL 33351, SUNRISE, FL 33351 |
| ZIP code: | 33351 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629725353 | 2022-03-02 | 2022-03-02 | 4706 NW 99TH AVE, SUNRISE, FL, 333514734, US | 4706 NW 99TH AVE, SUNRISE, FL, 333514734, US | |||||||||||||||
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| Phone | +1 954-687-9410 |
| Fax | 9546782608 |
Authorized person
| Name | DARLENE VALCIN |
| Role | ARNP/FAMILY NURSE PRACTITIONER |
| Phone | 9546879410 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VALCIN, DARLENE | Agent | 4706 NW 99TH AVE, SUNRISE, FL 33351, SUNRISE, FL 33351 |
| Name | Role | Address |
|---|---|---|
| VALCIN, DARLENE | Manager | 4706 NW 99TH AVE, SUNRISE, FL 33351 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-16 |
| ANNUAL REPORT | 2023-01-30 |
| Florida Limited Liability | 2022-02-03 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
