| Entity Name: | WINGS OF LOVE OF LEESBURG, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Oct 2007 (17 years ago) |
| Document Number: | L07000106048 |
| FEI/EIN Number | 300472838 |
| Address: | 1016 E. North Blvd., LEESBURG, FL, 34748, US |
| Mail Address: | P O BOX 491077, LEESBURG, FL, 34749, US |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346407111 | 2008-05-20 | 2008-05-20 | PO BOX 491077, LEESBURG, FL, 347491077, US | 1018 W NORTH BLVD, LEESBURG, FL, 347485057, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 352-360-0660 |
| Fax | 3523600567 |
Authorized person
| Name | MR. PERNELL MITCHELL |
| Role | PRESIDENT |
| Phone | 3523600660 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| License Number | 688587096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | VENDOR NUMBER |
| Number | F342051880001 |
| State | FL |
| Issuer | FAMILY & SUPPORT LIVING WAIVER |
| Number | 688587098 |
| State | FL |
| Issuer | MEDWAIVER PROVIDER NUMBER |
| Number | 688587096 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MITCHELL RUBY V | Agent | 1016 E. North Blvd., LEESBURG, FL, 34748 |
| Name | Role | Address |
|---|---|---|
| MITCHELL PERNELL S | Manager | P.O. BOX 491033, LEESBURG, FL, 34749 |
| MITCHELL RUBY V | Manager | P.O. BOX 491033, LEESBURG, FL, 34749 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-26 | 1016 E. North Blvd., LEESBURG, FL 34748 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-26 | 1016 E. North Blvd., LEESBURG, FL 34748 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-30 | 1016 E. North Blvd., LEESBURG, FL 34748 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-03-31 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-05-04 |
| ANNUAL REPORT | 2017-04-08 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
