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  5. NEULIFE NEUROLOGICAL SERVICES LLC

NEULIFE NEUROLOGICAL SERVICES LLC

Company Details

Entity Name: NEULIFE NEUROLOGICAL SERVICES LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 26 Oct 2012 (12 years ago)
Document Number: L12000136809
FEI/EIN Number 461275163
Address: 2725 ROBIE AVENUE, MT DORA, FL, 32757, US
Mail Address: 135 W. Bay Street, Ste 400, Jacksonville, FL, 32202, US
ZIP code: 32757
County: Lake
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1548636467 2015-08-14 2017-11-28 2725 ROBIE AVE, MOUNT DORA, FL, 327579619, US 2725 ROBIE AVE, MOUNT DORA, FL, 327579619, US

Contacts
Phone +1 800-626-3876

Authorized person
Name JANET OTT
Role ADMINISTRATOR
Phone 3524097477

Taxonomy
Taxonomy Code 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF)
State FL
Is Primary No
Taxonomy Code 283X00000X - Rehabilitation Hospital
License Number 12406
State FL
Is Primary No
Taxonomy Code 283X00000X - Rehabilitation Hospital
License Number 70090977
State FL
Is Primary No
Taxonomy Code 310400000X - Assisted Living Facility
License Number AL12406
State FL
Is Primary No
Taxonomy Code 313M00000X - Nursing Facility/Intermediate Care Facility
License Number 12406
State FL
Is Primary No
Taxonomy Code 320700000X - Physical Disabilities Residential Treatment Facility
License Number 70090977
State FL
Is Primary Yes
Taxonomy Code 320700000X - Physical Disabilities Residential Treatment Facility
License Number AL12406
State FL
Is Primary No
Taxonomy Code 385H00000X - Respite Care
License Number AL12406
State FL
Is Primary No

Other Provider Identifiers
Issuer AHCA
Number AL12406
State FL

Central Index Key

CIK number Mailing Address Business Address Phone
1629429 135 WEST BAY STREET, SUITE 400, JACKSONVILLE, FL, 32202 135 WEST BAY STREET, SUITE 400, JACKSONVILLE, FL, 32202 904-598-1110

Filings since 2016-09-28
Form type D
File number 021-271451
Filing date 2016-09-28
File View File

Filings since 2014-12-30
Form type D
File number 021-231078
Filing date 2014-12-30
File View File

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
NEULIFE NEUROLOGICAL SERVICES 401(K) PROFIT SHARING PLAN AND T 2023 461275163 2024-09-17 NEULIFE NEUROLOGICAL SERVICES 139
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 3527203260
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 32757

Signature of
Role Plan administrator
Date 2024-09-17
Name of individual signing NICK RICE
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401K PROFIT SHARING PLAN & TRUST 2020 461275163 2021-11-05 NEULIFE NEUROLOGICAL SERVICES 89
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 9048384445
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 327579619

Signature of
Role Plan administrator
Date 2021-11-05
Name of individual signing PATRICIA BRAUN
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401(K) PROFIT SHARING PLAN & TRUST 2019 461275163 2020-07-29 NEULIFE NEUROLOGICAL SERVICES 87
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 3527203485
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 327579619

Signature of
Role Plan administrator
Date 2020-07-29
Name of individual signing BRIGITTE BECKLES
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401 K PROFIT SHARING PLAN TRUST 2018 461275163 2019-07-18 NEULIFE NEUROLOGICAL SERVICES 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 3527203261
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 327579619

Signature of
Role Plan administrator
Date 2019-07-18
Name of individual signing RUTH WALLACE
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401 K PROFIT SHARING PLAN TRUST 2017 461275163 2018-05-25 NEULIFE NEUROLOGICAL SERVICES 100
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 3527203258
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 327579619

Signature of
Role Plan administrator
Date 2018-05-25
Name of individual signing BONNIE CAPPELLO
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401 K PROFIT SHARING PLAN TRUST 2016 461275163 2017-07-14 NEULIFE NEUROLOGICAL SERVICES 74
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 9048384445
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 327579619

Signature of
Role Plan administrator
Date 2017-07-14
Name of individual signing BONNIE CAPPELLO
Valid signature Filed with authorized/valid electronic signature
NEULIFE NEUROLOGICAL SERVICES 401 K PROFIT SHARING PLAN TRUST 2015 461275163 2016-07-14 NEULIFE NEUROLOGICAL SERVICES 45
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2015-01-01
Business code 812990
Sponsor’s telephone number 3527203261
Plan sponsor’s address 2725 ROBIE AVE, MOUNT DORA, FL, 32757

Signature of
Role Plan administrator
Date 2016-07-14
Name of individual signing STACY OSEBOLD
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
VOLPE TIMOTHY WEsq. Agent 501 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32202

President

Name Role Address
Welch Tera President 2725 Robie Avenue, Mount Dora, FL, 32757

Manager

Name Role Address
Upchurch Michael Manager 2725 Robie Avenue, Mount Dora, FL, 32757

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G14000033487 NEULIFE EXPIRED 2014-04-03 2019-12-31 No data 135 W BAY STREET, SUITE 400, JACKSONVILLE, FL, 32202

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-03-15 2725 ROBIE AVENUE, MT DORA, FL 32757 No data
REGISTERED AGENT ADDRESS CHANGED 2019-04-30 501 RIVERSIDE AVENUE, Suite 601, JACKSONVILLE, FL 32202 No data
CHANGE OF PRINCIPAL ADDRESS 2014-01-22 2725 ROBIE AVENUE, MT DORA, FL 32757 No data
REGISTERED AGENT NAME CHANGED 2013-04-29 VOLPE, TIMOTHY W, Esq. No data

Documents

Name Date
ANNUAL REPORT 2024-03-15
ANNUAL REPORT 2023-03-30
ANNUAL REPORT 2022-01-27
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-05-13
ANNUAL REPORT 2019-04-30
ANNUAL REPORT 2018-03-13
AMENDED ANNUAL REPORT 2017-01-30
ANNUAL REPORT 2017-01-24
AMENDED ANNUAL REPORT 2016-02-22

Related by officers

Upchurch Michael

MBD1, LLC

VOLPE TIMOTHY WEsq.

CFL GROUP, LLC VOLPE, BAJALIA, WICKES, ROGERSON & WACHS, P.A.

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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