| Entity Name: | SUPREME HABILITATIVE SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Jul 2020 (5 years ago) |
| Document Number: | L20000221530 |
| FEI/EIN Number | 85-2176383 |
| Address: | 702 W Spruce St #1694, TAMPA, FL, 33607, US |
| Mail Address: | 702 W Spruce St #1694, TAMPA, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730759168 | 2021-06-28 | 2021-11-27 | 100 S ASHLEY DR STE 600, TAMPA, FL, 336025300, US | 100 S ASHLEY DR STE 600, TAMPA, FL, 336025300, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 866-751-8330 |
| Fax | 8139220553 |
| Phone | +1 813-381-0595 |
Authorized person
| Name | MRS. RACKAYE J SIMMONS |
| Role | CEO |
| Phone | 8667518330 |
Taxonomy
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | No |
| Taxonomy Code | 3104A0630X - Assisted Living Facility (Behavioral Disturbances) |
| Is Primary | No |
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 374U00000X - Home Health Aide |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 01 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIMMONS RACKAYE J | Agent | 100 S ASHLEY DR, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| SIMMONS RACKAYE J | Manager | 100 S ASHLEY DR, TAMPA, FL, 33602 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-23 | 702 W Spruce St #1694, TAMPA, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-23 | 702 W Spruce St #1694, TAMPA, FL 33607 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-16 | 100 S ASHLEY DR, STE 600, TAMPA, FL 33602 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-16 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-02-02 |
| Florida Limited Liability | 2020-07-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
