| Entity Name: | SPECIAL METHODS IN LIFE ENRICHMENT SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 03 May 2018 (7 years ago) |
| Document Number: | L18000111992 |
| FEI/EIN Number | 83-3174309 |
| Address: | 7187 Overland Park east blvd, JACKSONVILLE, FL 32244 |
| Mail Address: | 7187 Overland Park East Blvd, JACKSONVILLE, FL 32244 |
| ZIP code: | 32244 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336602093 | 2019-04-10 | 2024-04-19 | 7187 OVERLAND PARK BLVD E, JACKSONVILLE, FL, 322444254, US | 7187 OVERLAND PARK BLVD E, JACKSONVILLE, FL, 322444254, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-418-1440 |
Authorized person
| Name | SHAKYNA R HATHORN |
| Role | OWNER |
| Phone | 9044181440 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 104041100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 120201500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HATHORN, SHAKYNA | Agent | 7187 Overland Park East Blvd, JACKSONVILLE, FL 32244 |
| Name | Role | Address |
|---|---|---|
| HATHORN, SHAKYNA R | Owner | 7187 Overland Park East Blvd, JACKSONVILLE, FL 32244 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-20 | 7187 Overland Park east blvd, JACKSONVILLE, FL 32244 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-20 | 7187 Overland Park east blvd, JACKSONVILLE, FL 32244 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-20 | 7187 Overland Park East Blvd, JACKSONVILLE, FL 32244 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-04-09 |
| ANNUAL REPORT | 2021-05-04 |
| ANNUAL REPORT | 2020-05-12 |
| ANNUAL REPORT | 2019-01-16 |
| Florida Limited Liability | 2018-05-03 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1060828704 | 2021-03-26 | 0491 | PPP | 6316 San Juan Ave Ste 41E, Jacksonville, FL, 32210-2883 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Feb 2025
Sources: Florida Department of State
