| Entity Name: | 1ST LIGHT OF HOPE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Feb 2020 (5 years ago) |
| Document Number: | L20000046764 |
| FEI/EIN Number | 84-4812166 |
| Address: | 118 SW Andover Court, PORT SAINT LUCIE, FL, 34953, US |
| Mail Address: | 118 SW Andover Court, PORT SAINT LUCIE, FL, 34953, US |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497349625 | 2021-02-28 | 2021-02-28 | 4451 SW DARLINGTON ST, PORT SAINT LUCIE, FL, 349537607, US | 118 SW ANDOVER CT, PORT SAINT LUCIE, FL, 349536961, US | |||||||||||||||||||||
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| Phone | +1 772-214-5860 |
| Fax | 8008542598 |
Authorized person
| Name | MR. DON DURANTE ANDREWS |
| Role | OWNER |
| Phone | 7722145860 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1262 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ANDREWS DON | Agent | 4451 SW DARLING ST, PORT SAINT LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| BROWN KEITH | Owne | 2670 NE Breezeway Cir, Ocean Breeze, FL, 34957 |
| ANDREWS DON | Owne | 4451 SW DARLING ST, PORT SAINT LUCIE, FL, 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-04 | 118 SW Andover Court, PORT SAINT LUCIE, FL 34953 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-04 | 118 SW Andover Court, PORT SAINT LUCIE, FL 34953 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| AMENDED ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2024-01-09 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-02-04 |
| ANNUAL REPORT | 2021-04-10 |
| Florida Limited Liability | 2020-02-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
