| Entity Name: | PRESTIGE HOME CARE SERVICES OF BROWARD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 May 2003 (22 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 18 Nov 2015 (9 years ago) |
| Document Number: | P03000058649 |
| FEI/EIN Number | 010785065 |
| Address: | 2450 HOLLYWOOD BLVD, 102, HOLLYWOOD, FL, 33020 |
| Mail Address: | 2450 HOLLYWOOD BLVD, 102, HOLLYWOOD, FL, 33020 |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518045988 | 2006-11-01 | 2023-08-24 | 2450 HOLLYWOOD BLVD, SUITE 102, HOLLYWOOD, FL, 33020, US | 2450 HOLLYWOOD BLVD, SUITE 102, HOLLYWOOD, FL, 33020, US | |||||||||||||||||||||||||
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| Phone | +1 954-926-2595 |
| Fax | 9549266742 |
Authorized person
| Name | MR. LUIS LIZARAZO |
| Role | ADMINISTRATOR |
| Phone | 9549262595 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 299992546 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116408900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Lizarazo Luz | Agent | 2450 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| Lizarazo Luis | Chief Executive Officer | 2450 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| Sosa-Guerrero Sandy | Director | 2450 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33020 |
| Hernandez Yoely | Director | 2450 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33020 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-24 | Lizarazo, Luz | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-24 | 2450 HOLLYWOOD BLVD, 102, HOLLYWOOD, FL 33020 | No data |
| MERGER | 2015-11-18 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000156349 |
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-07 | 2450 HOLLYWOOD BLVD, 102, HOLLYWOOD, FL 33020 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-07 | 2450 HOLLYWOOD BLVD, 102, HOLLYWOOD, FL 33020 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-03-24 |
| AMENDED ANNUAL REPORT | 2022-05-19 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-23 |
| AMENDED ANNUAL REPORT | 2020-10-30 |
| AMENDED ANNUAL REPORT | 2020-10-19 |
| AMENDED ANNUAL REPORT | 2020-10-16 |
| AMENDED ANNUAL REPORT | 2020-09-03 |
| ANNUAL REPORT | 2020-01-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
