| Entity Name: | GRAND CANYON GROUP HOME LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Aug 2021 (3 years ago) |
| Document Number: | L21000386851 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 949 GRAND CANYON DRIVE, VALRICO, FL, 33594, US |
| Mail Address: | PO BOX 963, VALRICO, FL, 33595, US |
| ZIP code: | 33594 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477278232 | 2022-10-04 | 2022-10-04 | PO BOX 963, VALRICO, FL, 335950963, US | 949 GRAND CANYON DR, VALRICO, FL, 335944351, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-530-0004 |
| Fax | 8138621072 |
Authorized person
| Name | CASSANDRA VIRGINIA SIMPSON |
| Role | DIRECTOR |
| Phone | 8138106844 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251J00000X - Nursing Care Agency |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 385HR2060X - Child Intellectual and/or Developmental Disabilities Respite Care |
| Is Primary | No |
| Name | Role |
|---|---|
| FOCUS 9 ENTERPRISES LLC | Agent |
| Name | Role | Address |
|---|---|---|
| SIMPSON CASSANDRA V | Manager | 210 S PARSONS AVE, BRANDON, FL, 33511 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-25 | FOCUS 9 ENTERPRISES LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-12 | 2728 ENTERPRISE RD, STE 200, ORANGE CITY, FL 32763 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-12 |
| Florida Limited Liability | 2021-08-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
