| Entity Name: | GREATER GOOD LIFE SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Nov 2015 (9 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 27 Nov 2023 (a year ago) |
| Document Number: | L15000195332 |
| FEI/EIN Number | 47-5672382 |
| Address: | 1253 W Memorial Blvd, LAKELAND, FL 33815 |
| Mail Address: | 1253 W Memorial Blvd, LAKELAND, FL 33815 |
| ZIP code: | 33815 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245770221 | 2017-02-24 | 2017-02-24 | 2033 E EDGEWOOD DR, SUITE 4, LAKELAND, FL, 338033660, US | 2033 E EDGEWOOD DR, SUITE 4, LAKELAND, FL, 338033660, US | |||||||||||||||||||||||
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| Phone | +1 863-271-7972 |
Authorized person
| Name | HEATHER STAMBAUGH |
| Role | OWNER |
| Phone | 8632717972 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH11554 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 007986200 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| STAMBAUGH, HEATHER E | Authorized Member | 2033 E EDGEWOOD DRIVE, SUITE 4, LAKELAND, FL 33803 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000062600 | LAKELAND THERAPY FOR MISFITS | ACTIVE | 2024-05-14 | 2029-12-31 | No data | 2033 E. EDGEWOOD DRIVE, SUITE 4, LAKELAND, FL, 33803 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-28 | 1253 W Memorial Blvd, LAKELAND, FL 33815 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-28 | 1253 W Memorial Blvd, LAKELAND, FL 33815 | No data |
| LC STMNT OF RA/RO CHG | 2023-11-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-11-27 | REGISTERED AGENTS INC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-11-27 | 7901 4TH ST N, STE 300, ST PETERSBUR, FL 33702 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| CORLCRACHG | 2023-11-27 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-01-18 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-02-20 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-05-06 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
