| Entity Name: | ISLAND LIFE MENTAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Jun 2018 (7 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 19 Feb 2019 (6 years ago) |
| Document Number: | L18000151353 |
| FEI/EIN Number | 83-0997255 |
| Address: | 5666 Seminole Blvd, SEMINOLE, FL, 33772, US |
| Mail Address: | 5666 Seminole Blvd, SEMINOLE, FL, 33772, US |
| ZIP code: | 33772 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881175925 | 2018-08-27 | 2018-09-24 | 8253 113TH ST, SEMINOLE, FL, 337724128, US | 8253 113TH ST, SEMINOLE, FL, 337724128, US | |||||||||||||
|
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| Phone | +1 727-295-5050 |
Authorized person
| Name | TRACEY SANDERBECK |
| Role | PROVIDER |
| Phone | 7272955050 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SANDERBECK TRACEY A | Agent | 5666 Seminole Blvd, SEMINOLE, FL, 33772 |
| Name | Role | Address |
|---|---|---|
| NAUMAN JEANNETTE | Manager | 5666 Seminole Blvd, SEMINOLE, FL, 33772 |
| SANDERBECK TRACEY AARNP-PM | Manager | 8253 113th Street North, SEMINOLE, FL, 33772 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-07 | 5666 Seminole Blvd, #109, SEMINOLE, FL 33772 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-07 | 5666 Seminole Blvd, #109, SEMINOLE, FL 33772 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-07 | 5666 Seminole Blvd, #109, SEMINOLE, FL 33772 | No data |
| LC NAME CHANGE | 2019-02-19 | ISLAND LIFE MENTAL HEALTH, LLC | No data |
| LC AMENDMENT | 2018-07-02 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-10 |
| ANNUAL REPORT | 2020-04-01 |
| LC Name Change | 2019-02-19 |
| ANNUAL REPORT | 2019-02-14 |
| LC Amendment | 2018-07-02 |
| Florida Limited Liability | 2018-06-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
