| Entity Name: | PCHP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jan 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 06 Dec 2022 (2 years ago) |
| Document Number: | M22000000083 |
| FEI/EIN Number | 82-2755453 |
| Address: | 2002 N. Lois Ave, TAMPA, FL, 33607, US |
| Mail Address: | P.O. Box 20547, TAMPA, FL, 33622, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | INDIANA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821597444 | 2018-02-09 | 2024-03-12 | PO BOX 20547, TAMPA, FL, 336220547, US | 5660 W CYPRESS ST STE G, TAMPA, FL, 336071777, US | |||||||||||||||||||||
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| Phone | +1 813-812-4161 |
| Phone | +1 317-245-7482 |
Authorized person
| Name | SUSAN ELAINE RAWLINGS |
| Role | CEO |
| Phone | 8138124161 |
Taxonomy
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | Q051562 |
| State | TN |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 S PINE ISLAND RD, PLANTATION, FL, 33324 |
| Name | Role | Address |
|---|---|---|
| RAWLINGS MOLINA SUSAN | Member | 5660 WEST CYPRESS STREET, TAMPA, FL, 33607 |
| AKULA SRIDHAR | Member | 5660 WEST CYPRESS STREET, TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-09-17 | 2002 N. Lois Ave, Suite 200, TAMPA, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2024-09-17 | 2002 N. Lois Ave, Suite 200, TAMPA, FL 33607 | No data |
| LC AMENDMENT | 2022-12-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-01 |
| ANNUAL REPORT | 2023-01-06 |
| LC Amendment | 2022-12-06 |
| Foreign Limited | 2022-01-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
