| Entity Name: | PUTNAM FAMILY CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jun 2002 (23 years ago) |
| Document Number: | P02000071069 |
| FEI/EIN Number | 810559052 |
| Address: | 6101 CRILL AVENUE, PALATKA, FL, 32177 |
| Mail Address: | 6101 CRILL AVE., PALATKA, FL, 32177 |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205840519 | 2006-07-29 | 2013-07-16 | 6101 CRILL AVE, PALATKA, FL, 321773875, US | 6101 CRILL AVE, PALATKA, FL, 321773875, US | |||||||||||||||||||||||
|
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| Phone | +1 386-326-1225 |
Authorized person
| Name | JERRY JACOBSON |
| Role | VP |
| Phone | 3863261225 |
Taxonomy
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| License Number | 54QP00053 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 267777600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JERRY JACOBSON | Agent | 6101 CRILL AVE., PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| BOHN DEREK S | Vice President | 6101 CRILL AVE., PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| BOHN DEREK S | Treasurer | 6101 CRILL AVE., PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| JACOBSON JERRY | President | 6101 CRILL AVE., PALATKA, FL, 32177 |
| Name | Role | Address |
|---|---|---|
| JACOBSON JERRY | Secretary | 6101 CRILL AVE., PALATKA, FL, 32177 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-21 | JERRY, JACOBSON | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-01-31 | 6101 CRILL AVE., PALATKA, FL 32177 | No data |
| CHANGE OF MAILING ADDRESS | 2004-04-14 | 6101 CRILL AVENUE, PALATKA, FL 32177 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-03-15 |
| ANNUAL REPORT | 2019-02-17 |
| ANNUAL REPORT | 2018-01-19 |
| ANNUAL REPORT | 2017-01-18 |
| ANNUAL REPORT | 2016-01-20 |
| ANNUAL REPORT | 2015-03-14 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
