| Entity Name: | BLACK ROCK PRIMARY CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Jun 2023 (2 years ago) |
| Document Number: | L23000300721 |
| FEI/EIN Number | 472865314 |
| Address: | 3379 W WOOLOBRIGHT RD, BOYNTON BEACH, FL, 33436, US |
| Mail Address: | 11924 FOREST HILL BLVD, STE 10A-413, WELLINGTON, FL, 33414, US |
| ZIP code: | 33436 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| Name | Role | Address |
|---|---|---|
| ANDERS CHERYL | Agent | 11924 FOREST HILL BLVD, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| ACLOQUE JUDE | Manager | 11924 FOREST HILL BLVD STE 10A-413, WELLINGTON, FL, 33414 |
| Name | Role |
|---|---|
| PROVIDERS HEALTH ALLIANCE, LLC | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000079400 | OBSIDIAN HEALTHCARE | ACTIVE | 2023-07-05 | 2028-12-31 | No data | 11924 FOREST HILL BLVD, STE 10A-413, WELLINGTON, FL, 33414 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| Florida Limited Liability | 2023-06-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
