| Entity Name: | PRIME CARE ONE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 10 Mar 1997 (28 years ago) |
| Date of dissolution: | 25 Apr 2022 (3 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 25 Apr 2022 (3 years ago) |
| Document Number: | M97000000117 |
| FEI/EIN Number | 352007426 |
| Address: | 450 E. 96th Street, Suite 500, INDIANAPOLIS, IN, 46240, US |
| Place of Formation: | INDIANA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447327648 | 2006-11-30 | 2014-12-30 | 1440 HIGHWAY A1A, VERO BEACH, FL, 329632310, US | 950 PINEBROOK RD, VENICE, FL, 342857147, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-492-5002 |
| Fax | 7724925005 |
| Phone | +1 941-484-8801 |
| Fax | 9414843450 |
Authorized person
| Name | MR. THOMAS MITCHELL |
| Role | CFO, MGMT CO. |
| Phone | 7724925002 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL8813 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130470962 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021332200 |
| State | FL |
| Name | Role |
|---|---|
| LEXISNEXIS DOCUMENT SOLUTIONS INC. | Agent |
| Name | Role | Address |
|---|---|---|
| HICKS JAY L | Managing Member | 450 E. 96th Street, INDIANAPOLIS, IN, 46240 |
| WHITMAN ARNOLD | Managing Member | 450 E. 96th Street, INDIANAPOLIS, IN, 46240 |
| DAVIES ROBERT N | Managing Member | 450 E. 96th Street, INDIANAPOLIS, IN, 46240 |
| Name | Role | Address |
|---|---|---|
| PHILLIPPE THOMAS E | Manager | 450 E. 96th Street, INDIANAPOLIS, IN, 46240 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000098380 | HARBORCHASE OF VENICE | EXPIRED | 2016-09-08 | 2021-12-31 | No data | 950 PINEBROOK ROAD, VENICE, FL, 34285 |
| G16000098386 | HARBORCHASE OF NAPLES | EXPIRED | 2016-09-08 | 2021-12-31 | No data | 7801 AIRPORT PULLING ROAD NORTH, NAPLES, FL, 34109 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2022-04-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-30 | 450 E. 96th Street, Suite 500, INDIANAPOLIS, IN 46240 | No data |
| LC STMNT OF RA/RO CHG | 2017-07-10 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2003-07-25 | LEXISNEXIS DOCUMENT SOLUTIONS INC. | No data |
| REINSTATEMENT | 2001-01-30 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2000-09-29 | No data | No data |
| REINSTATEMENT | 1999-11-30 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 1999-10-14 | No data | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2022-04-25 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-05-28 |
| ANNUAL REPORT | 2018-04-25 |
| CORLCRACHG | 2017-07-10 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-04-29 |
| ANNUAL REPORT | 2014-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
