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  5. PEA RIDGE FAMILY CARE CENTER, INC.

PEA RIDGE FAMILY CARE CENTER, INC.

Company Details

Entity Name: PEA RIDGE FAMILY CARE CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 09 Mar 1998 (27 years ago)
Document Number: P98000022536
FEI/EIN Number 593497418
Address: 5553 HWY. 90 WEST, PACE, FL, 32571
Mail Address: 5553 HWY. 90 WEST, PACE, FL, 32571
ZIP code: 32571
County: Santa Rosa
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1013587955 2021-07-01 2021-07-01 5553 HIGHWAY 90, PACE, FL, 325711540, US 5500 N DAVIS HWY STE 2, PENSACOLA, FL, 325032063, US

Contacts
Phone +1 850-995-8811
Fax 8509958810
Phone +1 850-475-0867
Fax 8504750895

Authorized person
Name PURUSHOTTAM K. GARG
Role OWNER
Phone 8509958811

Taxonomy
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2018 593497418 2019-09-16 PEA RIDGE FAMILY CARE CENTER, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2019-09-16
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2017 593497418 2018-07-31 PEA RIDGE FAMILY CARE CENTER, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2018-07-31
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2016 593497418 2017-10-13 PEA RIDGE FAMILY CARE CENTER, INC. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2017-10-13
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2015 593497418 2016-08-24 PEA RIDGE FAMILY CARE CENTER, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2016-08-24
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2014 593497418 2015-10-15 PEA RIDGE FAMILY CARE CENTER, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2013 593497418 2014-10-14 PEA RIDGE FAMILY CARE CENTER, INC. 7
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-10-14
Name of individual signing P K GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. 401(K) PLAN 2012 593497418 2013-10-15 PEA RIDGE FAMILY CARE CENTER, INC. 6
File View Page
Three-digit plan number (PN) 002
Effective date of plan 2012-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Signature of
Role Plan administrator
Date 2013-10-15
Name of individual signing PURUSHOTTAM K. GARG
Valid signature Filed with authorized/valid electronic signature
PEA RIDGE FAMILY CARE CENTER, INC. PROFIT SHARING PLAN AND TRUST 2009 593497418 2010-06-09 PEA RIDGE FAMILY CARE CENTER, INC. 5
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1998-01-01
Business code 621111
Sponsor’s telephone number 8509958811
Plan sponsor’s address 5553 HIGHWAY 90, PACE, FL, 32571

Plan administrator’s name and address
Administrator’s EIN 593497418
Plan administrator’s name PEA RIDGE FAMILY CARE CENTER, INC.
Plan administrator’s address 5553 HIGHWAY 90, PACE, FL, 32571
Administrator’s telephone number 8509958811

Signature of
Role Plan administrator
Date 2010-06-09
Name of individual signing P.K. GARG
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-06-09
Name of individual signing P.K. GARG
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
GARG PURUSHOTTAM K Agent 5553 HWY. 90 WEST, PACE, FL, 32571

President

Name Role Address
GARG PURUSHOTTAM K President 5553 HWY. 90 WEST, PACE, FL, 32571

Secretary

Name Role Address
GARG ANJU M Secretary 5553 HWY. 90 WEST, PACE, FL, 32571

Treasurer

Name Role Address
GARG ANJU M Treasurer 5553 HWY. 90 WEST, PACE, FL, 32571

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G08141900135 DAVIS HWY FAMILY PRACTICE EXPIRED 2008-05-20 2013-12-31 No data 5500 N. DAVIS HWY, PENSACOLA, FL, 32503
G08141900154 WOODBINE NIGHT CLINIC EXPIRED 2008-05-20 2013-12-31 No data 5606 WOODBINE ROAD, PACE, FL, 32571

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2009-02-26 5553 HWY. 90 WEST, PACE, FL 32571 No data
CHANGE OF MAILING ADDRESS 2009-02-26 5553 HWY. 90 WEST, PACE, FL 32571 No data
REGISTERED AGENT ADDRESS CHANGED 2009-02-26 5553 HWY. 90 WEST, PACE, FL 32571 No data
REGISTERED AGENT NAME CHANGED 1999-03-03 GARG, PURUSHOTTAM K No data

Documents

Name Date
ANNUAL REPORT 2024-04-30
ANNUAL REPORT 2023-04-28
ANNUAL REPORT 2022-04-30
ANNUAL REPORT 2021-03-27
ANNUAL REPORT 2020-06-29
ANNUAL REPORT 2019-04-23
ANNUAL REPORT 2018-04-01
ANNUAL REPORT 2017-04-21
ANNUAL REPORT 2016-03-11
ANNUAL REPORT 2015-03-17

Related by officers

GARG PURUSHOTTAM K

ANG HOLDINGS LLC SNNP, INC. GARG FAMILY LIMITED PARTNERSHIP SOUTHERNTELEMED, LLC WELFARE INNOVATION FOUNDATION, INC. COOPERATIVE CARE STAFFING, INC. GARG FAMILY MEDICAL CLINIC, L.L.C. RECTION GOLF, L.L.C. ROBERTSDALE HOLDINGS, L.L.C. PRAKASHWATI PROPERTIES, L.L.C.

GARG ANJU M

STONE BROOK PLAZA, INC.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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