| Entity Name: | LIFE CARE COMPANIONS OF NORTHWEST FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Aug 2020 (4 years ago) |
| Date of dissolution: | 10 Dec 2023 (a year ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 10 Dec 2023 (a year ago) |
| Document Number: | L20000256436 |
| FEI/EIN Number | 201202454 |
| Address: | 8510 SONNYBOY LANE, PENSACOLA, FL, 32514, US |
| Mail Address: | 8741 Sonnyboy Lane, PENSACOLA, FL, 32514, US |
| ZIP code: | 32514 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255584868 | 2008-10-28 | 2013-09-10 | 8510 SONNYBOY LANE, PENSACOLA, FL, 32514, US | 8510 SONNYBOY LN, PENSACOLA, FL, 325143436, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-324-4617 |
| Fax | 8504629324 |
Authorized person
| Name | MS. PRISCILLA C BALDWIN |
| Role | ADMINISTRATOR |
| Phone | 8503244617 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 232860 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008276300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BALDWIN DEREK X | Agent | 8510 SONNYBOY LANE, PENSACOLA, FL, 32514 |
| Name | Role | Address |
|---|---|---|
| BALDWIN PRISCILLA | Authorized Member | 8510 SONNYBOY LANE, PENSACOLA, FL, 33514 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-12-10 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-25 | 8510 SONNYBOY LANE, PENSACOLA, FL 32514 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-25 | BALDWIN, DEREK X | No data |
| LC STMNT OF RA/RO CHG | 2022-09-23 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-09-23 | 8510 SONNYBOY LANE, PENSACOLA, FL 32514 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2023-12-10 |
| ANNUAL REPORT | 2023-01-25 |
| CORLCRACHG | 2022-09-23 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-04-12 |
| Florida Limited Liability | 2020-08-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
