| Entity Name: | EMPOWERED LIFE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jul 2019 (6 years ago) |
| Document Number: | L19000195089 |
| FEI/EIN Number | 84-2666996 |
| Address: | 3030 N Rocky Point Dr W, Tampa, FL, 33607, US |
| Mail Address: | 3030 N Rocky Point Dr W, Tampa, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205481843 | 2019-08-08 | 2019-08-08 | 709 W BAY ST, TAMPA, FL, 336062705, US | 709 W BAY ST, TAMPA, FL, 336062705, US | |||||||||||||||||||||||||||
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| Phone | +1 813-658-8071 |
| Fax | 8138200404 |
Authorized person
| Name | KATHERINE ROTH |
| Role | OWNER, THERAPIST |
| Phone | 2487613284 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PROVIDER NPI |
| Number | 1366981946 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1316290372 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Roth Katherine | Agent | 3030 N Rocky Point Dr W, Tampa, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| Roth Katherine | Authorized Member | 3030 N Rocky Point Dr W, Tampa, FL, 33607 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000096803 | EMPOWERED FAMILIES | EXPIRED | 2019-09-04 | 2024-12-31 | No data | 709 W BAY STREET, TAMPA, FL, 33606 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-05-01 | 3030 N Rocky Point Dr W, Suite 150, Tampa, FL 33607 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-18 | 3030 N Rocky Point Dr W, Suite 150, Tampa, FL 33607 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-02-18 | Roth, Katherine | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-18 | 3030 N Rocky Point Dr W, Suite 150, Tampa, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-02-18 |
| ANNUAL REPORT | 2020-03-20 |
| Florida Limited Liability | 2019-07-31 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
