| Entity Name: | DIVINE HEALING SENIOR AND DISABLED SERVICES L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Oct 2019 (5 years ago) |
| Document Number: | L19000249775 |
| FEI/EIN Number | 82-5419305 |
| Address: | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 |
| Mail Address: | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 |
| ZIP code: | 32343 |
| County: | Gadsden |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679194237 | 2020-05-05 | 2023-06-22 | 211 GAY ST, HAVANA, FL, 323331646, US | 8866 HIGH BRIDGE RD, MIDWAY, FL, 32343, US | |||||||||||||||||||||||||||
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| Phone | +1 850-274-7104 |
| Fax | 2397851707 |
Authorized person
| Name | DECORKUS ALLEN |
| Role | CEO |
| Phone | 8502747104 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021500500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 114242100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALLEN, DECORKUS | Agent | 211 Gay Street, HAVANA, FL 32333 |
| Name | Role | Address |
|---|---|---|
| ALLEN, DECORKUS VENTREZ, LORD | Chief Executive Officer | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 |
| Name | Role | Address |
|---|---|---|
| ALLEN, DECORKUS VENTREZ, LORD | Chief Financial Officer | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 |
| Name | Role | Address |
|---|---|---|
| ALLEN, DECORKUS VENTREZ, LORD | Chief Operating Officer | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-09-06 | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 | No data |
| CHANGE OF MAILING ADDRESS | 2023-09-06 | 8866 HIGHBRIDGE RD, MIDWAY, FL 32343 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-30 | 211 Gay Street, HAVANA, FL 32333 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-31 |
| ANNUAL REPORT | 2023-09-06 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-04-25 |
| Florida Limited Liability | 2019-10-16 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
