| Entity Name: | WELLSPRING ASSISTED LIVING FACILITY, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Oct 2005 (19 years ago) |
| Document Number: | L05000104727 |
| FEI/EIN Number | 203683320 |
| Mail Address: | P.O. BOX 280155, TAMPA, FL, 33682-0155, US |
| Address: | 37815 15TH AVENUE WEST, ZEPHYRHILLS, FL, 33542 |
| ZIP code: | 33542 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982905097 | 2010-11-04 | 2010-11-04 | PO BOX 280339, TAMPA, FL, 336820339, US | 37815 15TH AVE, ZEPHYRHILLS, FL, 335423217, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 813-715-1000 |
| Fax | 8134256925 |
Authorized person
| Name | MR. JOSEPH WILFRED JOSEPH |
| Role | MGR/ADMINISTRATOR |
| Phone | 8137151000 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10854 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| License Number | AL10854 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142709100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOSEPH JOSEPH W | Agent | 16205 Indian Mound Road, TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| JOSEPH JOSEPH | Manager | 16205 INDIAN MOUND ROAD, TAMPA, FL, 33618 |
| JOSEPH GEETHA | Manager | 16205 INDIAN MOUND ROAD, TAMPA, FL, 33618 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000091326 | WELLSPRING ASSISTED LIVING | ACTIVE | 2024-07-31 | 2029-12-31 | No data | PO BOX 280155, TAMPA, FL, 33682 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-07 | 16205 Indian Mound Road, TAMPA, FL 33618 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-08 | 37815 15TH AVENUE WEST, ZEPHYRHILLS, FL 33542 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-01-14 | JOSEPH, JOSEPH W | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-01-19 | 37815 15TH AVENUE WEST, ZEPHYRHILLS, FL 33542 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-05 |
| ANNUAL REPORT | 2021-01-09 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-03-07 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
