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  5. PROVIDENCE HEALTHCARE SERVICES, INC.

PROVIDENCE HEALTHCARE SERVICES, INC. - Florida Company Profile

Company Details

Entity Name: PROVIDENCE HEALTHCARE SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit

PROVIDENCE HEALTHCARE SERVICES, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 07 Jun 2007 (18 years ago)
Document Number: P07000067462
FEI/EIN Number 770688701

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 10250 SW 56 STREET, MIAMI, FL, 33165, US
Mail Address: 10250 SW 56 STREET, MIAMI, FL, 33165, US
ZIP code: 33165
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1609456458 2021-04-14 2021-04-14 10250 SW 56TH ST STE D103, MIAMI, FL, 331657065, US 10250 SW 56TH ST STE D103, MIAMI, FL, 331657065, US

Contacts
Phone +1 305-220-1088

Authorized person
Name NERCY B RADCLIFFE
Role ADMINISTRATOR
Phone 3052201088

Taxonomy
Taxonomy Code 251E00000X - Home Health Agency
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 651696300
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2023 770688701 2025-01-15 PROVIDENCE HEALTHCARE SERVICES 27
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33165
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2022 770688701 2023-09-30 PROVIDENCE HEALTHCARE SERVICES 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33166
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2021 770688701 2022-10-16 PROVIDENCE HEALTHCARE SERVICES 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33166
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2020 770688701 2021-10-11 PROVIDENCE HEALTHCARE SERVICES 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33166
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2019 770688701 2020-10-15 PROVIDENCE HEALTHCARE SERVICES 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33165
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2018 770688701 2019-04-16 PROVIDENCE HEALTHCARE SERVICES 32
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33165

Signature of
Role Plan administrator
Date 2019-04-16
Name of individual signing NERCY RADCLIFFE
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2017 770688701 2018-07-26 PROVIDENCE HEALTHCARE SERVICES 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 10250 SW 56TH STREET, SUITE D-103, MIAMI, FL, 33165

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing NERCY RADCLIFFE
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2016 770688701 2017-08-02 PROVIDENCE HEALTHCARE SERVICES 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 8505 NW 74TH STREET, STE. B, MIAMI, FL, 33166

Signature of
Role Plan administrator
Date 2017-08-02
Name of individual signing NERCY RADCLIFFE
Valid signature Filed with authorized/valid electronic signature
PROVIDENCE HEALTHCARE SERVICES 401(K) PROFIT SHARING PLAN 2015 770688701 2016-08-24 PROVIDENCE HEALTHCARE SERVICES 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-12-01
Business code 621610
Sponsor’s telephone number 3052201088
Plan sponsor’s address 8505 NW 74TH STREET, STE. B, MIAMI, FL, 33166

Key Officers & Management

Name Role Address
RADCLIFFE NERCY B President 10250 SW 56 ST, MIAMI, FL, 33165
RADCLIFFE NERCY B Secretary 10250 SW 56 ST, MIAMI, FL, 33165
RADCLIFFE NERCY B Treasurer 10250 SW 56 ST, MIAMI, FL, 33165
RADCLIFFE NERCY B Agent 10250 SW 56 ST, MIAMI, FL, 33165

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G10000064231 PROVIDENCE HEALTHCARE ACTIVE 2010-07-12 2025-12-31 - 10250 SW 56 STREET, STE D-103, MIAMI, FL, 33165

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2018-03-15 10250 SW 56 ST, STE D103, MIAMI, FL 33165 -
CHANGE OF PRINCIPAL ADDRESS 2017-11-06 10250 SW 56 STREET, SUITE D-103, MIAMI, FL 33165 -
CHANGE OF MAILING ADDRESS 2017-11-06 10250 SW 56 STREET, SUITE D-103, MIAMI, FL 33165 -
REGISTERED AGENT NAME CHANGED 2012-02-09 RADCLIFFE, NERCY B -

Documents

Name Date
ANNUAL REPORT 2024-02-15
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-03-14
ANNUAL REPORT 2021-02-01
ANNUAL REPORT 2020-02-10
ANNUAL REPORT 2019-02-21
ANNUAL REPORT 2018-03-15
ANNUAL REPORT 2017-01-09
ANNUAL REPORT 2016-07-07
ANNUAL REPORT 2015-03-25

Paycheck Protection Program

Loan Number Loan Funded Date SBA Origination Office Code Loan Delivery Method Borrower Street Address
2988408709 2021-03-30 0455 PPS 10250 SW 56th St D103, Miami, FL, 33165-7069
Loan Status Date 2023-02-11
Loan Status Paid in Full
Loan Maturity in Months 60
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 131855
Loan Approval Amount (current) 131855
Undisbursed Amount 0
Franchise Name -
Lender Location ID 121536
Servicing Lender Name Customers Bank
Servicing Lender Address 40 General Warren Blvd, Malvern, PA, 19355
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Miami, MIAMI-DADE, FL, 33165-7069
Project Congressional District FL-27
Number of Employees 41
NAICS code 621610
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 121536
Originating Lender Name Customers Bank
Originating Lender Address Malvern, PA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 134210.33
Forgiveness Paid Date 2023-01-26
9452257306 2020-05-02 0455 PPP 10250 SW 56 Street Suite D-103, Miami, FL, 33165
Loan Status Date 2022-03-23
Loan Status Paid in Full
Loan Maturity in Months 24
SBA Guaranty Percentage 100
Loan Approval Amount (at origination) 106185
Loan Approval Amount (current) 106185
Undisbursed Amount 0
Franchise Name -
Lender Location ID 456756
Servicing Lender Name Cross River Bank
Servicing Lender Address 885 Teaneck Rd, TEANECK, NJ, 07666-4546
Rural or Urban Indicator U
Hubzone N
LMI N
Business Age Description Existing or more than 2 years old
Project Address Miami, MIAMI-DADE, FL, 33165-1900
Project Congressional District FL-27
Number of Employees 33
NAICS code 621610
Borrower Race Unanswered
Borrower Ethnicity Unknown/NotStated
Business Type Corporation
Originating Lender ID 529113
Originating Lender Name Kabbage, Inc.
Originating Lender Address Atlanta, GA
Gender Unanswered
Veteran Unanswered
Forgiveness Amount 107529.04
Forgiveness Paid Date 2021-08-10

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PROVIDENCE HEALTHCARE, LLC - Active
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PROVIDENCE HEALTHCARE, LLC - Active
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Companies related by address

10250 SW 56 STREET, MIAMI, FL, 33165, US

ANA DIAZ-GONZALEZ, DPM, LLC PROVIDENCE HOMECARE, LLC

10250 SW 56 STREET, MIAMI, FL, 33165, US

ANA DIAZ-GONZALEZ, DPM, LLC PROVIDENCE HOMECARE, LLC

Date of last update: 01 Apr 2025

Sources: Florida Department of State

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