| Entity Name: | FAMILY LIFE CARE SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 Nov 2012 (12 years ago) |
| Document Number: | L12000139357 |
| FEI/EIN Number | 46-1297314 |
| Address: | 17680 NW 78 AVE, UNIT # 105, HIALEAH, FL 33015 |
| Mail Address: | 17680 NW 78 AVE, UNIT # 105, HIALEAH, FL 33015 |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558778605 | 2014-07-21 | 2021-11-15 | 17680 NW 78TH AVE STE 105, HIALEAH, FL, 330153667, US | 17680 NW 78TH AVE STE 105, HIALEAH, FL, 330153667, US | |||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 305-779-1068 |
| Fax | 3057791067 |
Authorized person
| Name | MR. DERICK R TORO |
| Role | PRESIDENT |
| Phone | 3057791068 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
| Taxonomy Code | 372600000X - Adult Companion |
| Is Primary | No |
| Taxonomy Code | 3747P1801X - Personal Care Attendant |
| Is Primary | No |
| Taxonomy Code | 374U00000X - Home Health Aide |
| Is Primary | No |
| Taxonomy Code | 376J00000X - Homemaker |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010923900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 007211400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TORO, DERICK | Agent | 4150 SW 141 AVE, MIRAMAR, FL 33027 |
| Name | Role | Address |
|---|---|---|
| TORO, DERICK | President | 4150 SW 141 AVE, Miramar, FL 33027 |
| Name | Role | Address |
|---|---|---|
| ROQUE, EVELYN EUFEMIA | Manager | 13211 SW 53 ST, Miramar, FL 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-14 | 4150 SW 141 AVE, MIRAMAR, FL 33027 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-16 | 17680 NW 78 AVE, UNIT # 105, HIALEAH, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-16 | 17680 NW 78 AVE, UNIT # 105, HIALEAH, FL 33015 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-02-09 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
