| Entity Name: | AT HOME PALLIATIVE CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jul 2022 (3 years ago) |
| Document Number: | L22000330140 |
| FEI/EIN Number | 88-3622488 |
| Address: | 463688 STATE ROAD 200, SUITE 1, #364, YULEE, FL, 32097, US |
| Mail Address: | 463688 STATE ROAD 200, SUITE 1, #364, YULEE, FL, 32097, US |
| ZIP code: | 32097 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790406148 | 2022-09-05 | 2022-09-05 | 463688 STATE ROAD 200, STE 1, #364, YULEE, FL, 32097, US | 10752 DEERWOOD PARK BLVD STE 100, JACKSONVILLE, FL, 322564846, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 478-290-0677 |
Authorized person
| Name | CRYSTAL CISZEK |
| Role | CEO |
| Phone | 4782900677 |
Taxonomy
| Taxonomy Code | 207QH0002X - Hospice and Palliative Medicine (Family Medicine) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CISZEK CRYSTAL | Agent | 463688 STATE ROAD 200, YULEE, FL, 32097 |
| Name | Role | Address |
|---|---|---|
| CISZEK CRYSTAL | Manager | 463688 STATE ROAD 200, SUITE 1 #364, YULEE, FL, 32097 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000097206 | AT HOME PALLIATIVE CARE | ACTIVE | 2022-08-17 | 2027-12-31 | No data | 463688 STATE ROAD 200, STE 1-364, YULEE, FL, 32097 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-10 |
| Florida Limited Liability | 2022-07-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
