| Entity Name: | TLC PROVIDERS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Feb 2000 (25 years ago) |
| Document Number: | P00000016536 |
| FEI/EIN Number | 593632784 |
| Address: | 8317 FRONT BEACH ROAD, SUITE 29A1, PANAMA CITY BEACH, FL, 32407 |
| Mail Address: | 8317 FRONT BEACH ROAD, SUITE 29A1, PANAMA CITY BEACH, FL, 32407 |
| ZIP code: | 32407 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417251638 | 2011-01-03 | 2011-01-03 | 8317 FRONT BEACH RD, SUITE 29A1, PANAMA CITY BEACH, FL, 324074885, US | 8317 FRONT BEACH RD, SUITE 29A1, PANAMA CITY BEACH, FL, 324074885, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 850-236-0073 |
| Fax | 8502360403 |
Authorized person
| Name | MR. TERRY WAYNE BOOKER |
| Role | OWNER/OPERATOR |
| Phone | 8502360073 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 679970198 |
| State | FL |
| Issuer | MEDICAID |
| Number | 679970196 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOOKER TERRY W | Agent | 325 EAGLE DRIVE, PANAMA CITY BEACH, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| BOOKER TERRY W | President | 325 EAGLE DRIVE, PANAMA CITY BEACH, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| BOOKER TERRY W | Director | 325 EAGLE DRIVE, PANAMA CITY BEACH, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| WILLIAMS MARY A | Secretary | 31 HARBESON AVE NE, FORT WALTON BEACH, FL, 32548 |
| Name | Role | Address |
|---|---|---|
| BOOKER CARMON J | Vice President | 325 EAGLE DR, PANAMA CITY BEACH, FL, 32407 |
| Name | Role | Address |
|---|---|---|
| Booker JoAnne | Asst | 325 Eagle Drive, Panama City Beach, FL, 32407 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000043128 | TERRY BOOKER GROUP HOMES | ACTIVE | 2011-05-04 | 2026-12-31 | No data | 8317 FRONT BEACH ROAD SUITE 29 A1, PANAMA CITY BEACH, FL, 32407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2004-10-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000738086 | ACTIVE | 1000001019893 | BAY | 2024-11-13 | 2034-11-20 | $ 2,667.59 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, PANAMA CITY SERVICE CENTER, 2480 SAINT ANDREWS BLVD, PANAMA CITY FL324052169 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
