| Entity Name: | 3D PROVIDERS CORPORATION |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Jul 2005 (20 years ago) |
| Date of dissolution: | 07 Jan 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 07 Jan 2020 (5 years ago) |
| Document Number: | P05000093741 |
| FEI/EIN Number | 542177360 |
| Address: | 111 SW Sabre Ave, LAKE CITY, FL, 32024, US |
| Mail Address: | 111 SW Sabre Ave, LAKE CITY, FL, 32024, US |
| ZIP code: | 32024 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1427206481 | 2008-09-03 | 2014-10-23 | 111 SW SABRE AVE, LAKE CITY, FL, 320240923, US | 144 SW WATERFORD CT, SUITE 101, LAKE CITY, FL, 320250767, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-755-3465 |
| Phone | +1 386-752-0024 |
Authorized person
| Name | DONNA DELBENE |
| Role | PRESIDENT |
| Phone | 3867520024 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| License Number | 1370 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 372600000X - Adult Companion |
| Is Primary | No |
| Taxonomy Code | 3747P1801X - Personal Care Attendant |
| Is Primary | No |
| Taxonomy Code | 376J00000X - Homemaker |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 385H00000X - Respite Care |
| Is Primary | Yes |
| Taxonomy Code | 385HR2065X - Child Physical Disabilities Respite Care |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID-WAIVER |
| Number | 679482396 |
| State | FL |
| Issuer | HEALTH CARE SERVICES POOL |
| Number | 1370 |
| State | FL |
| Issuer | HOMEMAKER & COMPANION /AHCA |
| Number | 232905 |
| State | FL |
| Issuer | ELDER OPTIONS |
| Number | 679482301 |
| State | FL |
| Issuer | FLORIDA SUPPORTED LIVING WAIVER |
| Number | 679482398 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DELBENE DONNA | Agent | 111 SW Sabre Ave, LAKE CITY, FL, 32024 |
| Name | Role | Address |
|---|---|---|
| Delbene Donna M | President | 111 SW Sabre Ave, LAKE CITY, FL, 32024 |
| Name | Role | Address |
|---|---|---|
| Delbene Donna M | Secretary | 111 SW Sabre Ave, LAKE CITY, FL, 32024 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000102397 | 3D STAFFING | EXPIRED | 2010-11-08 | 2015-12-31 | No data | 322 S. MARION AVE, LAKE CITY, FL, 32025 |
| G08329900354 | THEWIGSTOP | EXPIRED | 2008-11-24 | 2013-12-31 | No data | 111 SW SABRE AVE, LAKE CITY, FL, 32024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-01-07 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-05 | 111 SW Sabre Ave, LAKE CITY, FL 32024 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-05 | 111 SW Sabre Ave, LAKE CITY, FL 32024 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-05 | 111 SW Sabre Ave, LAKE CITY, FL 32024 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-11-22 | DELBENE, DONNA | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-01-07 |
| ANNUAL REPORT | 2019-02-05 |
| AMENDED ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-26 |
| ANNUAL REPORT | 2016-03-28 |
| AMENDED ANNUAL REPORT | 2015-11-10 |
| ANNUAL REPORT | 2015-01-22 |
| ANNUAL REPORT | 2014-02-05 |
| ANNUAL REPORT | 2013-02-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
