| Entity Name: | BOSTON MEDICAL CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 24 May 2022 (3 years ago) |
| Document Number: | L22000241685 |
| FEI/EIN Number | 88-2888722 |
| Address: | 3903 Dr. Martin Luther King Jr., FORT MYERS, FL 33916 |
| Mail Address: | 3903 Dr Martin Luther King Jr Blvd, Fort Myers, FL 33916 |
| ZIP code: | 33916 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245936293 | 2023-02-01 | 2024-08-09 | 3903 DR MARTIN LUTHER KING BLVD, FORT MYERS, FL, 339164805, US | 3903 DR MARTIN LUTHER KING BLVD, FORT MYERS, FL, 339164805, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 239-851-7500 |
Authorized person
| Name | MS. ELISE G LEWIS |
| Role | OPERATIONS MANAGER |
| Phone | 2392061200 |
Taxonomy
| Taxonomy Code | 163W00000X - Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 251300000X - Local Education Agency (LEA) |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 305S00000X - Point of Service |
| Is Primary | Yes |
| Taxonomy Code | 311ZA0620X - Adult Care Home Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1679209142 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEWIS, EVELYN | Agent | 3903 Dr Martin Luther King Jr Blvd, FORT MYERS, FL 33916 |
| Name | Role | Address |
|---|---|---|
| LEWIS, ELISE | Operations Manager | 3903 Dr Martin Luther Jr Blvd, FORT MYERS, FL 33916 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000059912 | THE BOSTON COMPANY | ACTIVE | 2023-05-12 | 2028-12-31 | No data | 3903 DR.MARTIN LUTHER KING JR BLVD, FORT. MYERS, FL, 33916 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-29 | 3903 Dr. Martin Luther King Jr., FORT MYERS, FL 33916 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-29 | 3903 Dr. Martin Luther King Jr., FORT MYERS, FL 33916 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-29 | 3903 Dr Martin Luther King Jr Blvd, FORT MYERS, FL 33916 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-04-29 |
| Florida Limited Liability | 2022-05-24 |
Date of last update: 12 Jan 2025
Sources: Florida Department of State
