| Entity Name: | ABUNDANT LIFE HOME HEALTH AGENCY LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Mar 2007 (18 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 03 Nov 2023 (a year ago) |
| Document Number: | L07000030688 |
| FEI/EIN Number | 920202533 |
| Address: | 28050 US HWY. 19 N, SUITE 205, CLEARWATER, FL, 33761, US |
| Mail Address: | 28050 US HWY. 19 N, SUITE 205, CLEARWATER, FL, 33761, US |
| ZIP code: | 33761 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609523604 | 2022-03-09 | 2022-03-23 | 6601 MEMORIAL HWY STE 106, TAMPA, FL, 336154501, US | 6601 MEMORIAL HWY STE 106, TAMPA, FL, 336154501, US | |||||||||||||||||||||||||||
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| Phone | +1 727-286-8916 |
| Fax | 7277241201 |
Authorized person
| Name | TRACI BRISSETT |
| Role | DIRECTOR OF NURSING |
| Phone | 7272868916 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 111860500 |
| State | FL |
| Issuer | AHCA LICENSE |
| Number | 299994461 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ABUNDANT LIFE HOME HEALTH AGENCY 401(K) PLAN | 2023 | 920202533 | 2024-09-24 | ABUNDANT LIFE HOME HEALTH AGENCY | 52 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-24 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621610 |
| Sponsor’s telephone number | 7272868916 |
| Plan sponsor’s address | 28050 US HWY 19 N, SUITE 205, CLEARWATER, FL, 33761 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-11 |
| Name of individual signing | MICHAEL VANDERFORD |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Ben Wallace | Agent | 28050 US HWY. 19 N, CLEARWATER, FL, 33761 |
| Name | Role | Address |
|---|---|---|
| SCHNAPER OWEN | Manager | 28870 US HWY 19 N., SUITE 205, CLEARWATER, FL, 33761 |
| WALLACE BENJAMIN | Manager | 28870 US HWY 19 N., SUITE 205, CLEARWATER, FL, 33761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-07-12 | Ben, Wallace | No data |
| LC AMENDMENT | 2023-11-03 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2015-02-24 | 28050 US HWY. 19 N, SUITE 205, CLEARWATER, FL 33761 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-02-24 | 28050 US HWY. 19 N, SUITE 205, CLEARWATER, FL 33761 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-10-16 | 28050 US HWY. 19 N, SUITE 205, CLEARWATER, FL 33761 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000471947 | TERMINATED | 1000000476452 | PINELLAS | 2013-02-13 | 2023-02-20 | $ 1,153.25 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CLEARWATER SERVICE CENTER, 19337 US HIGHWAY 19 N STE 200, CLEARWATER FL337643149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-12 |
| LC Amendment | 2023-11-03 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-02-28 |
| ANNUAL REPORT | 2016-02-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
