| Entity Name: | HEART OF GOLD SUPERIOR LAB SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Sep 2021 (3 years ago) |
| Document Number: | L21000391925 |
| FEI/EIN Number | 872456906 |
| Address: | 801 West State Road 436, Altamonte Springs, FL, 32714, US |
| Mail Address: | 801 West State Road 436, Altamonte Springs, FL, 32714, US |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447921234 | 2021-09-22 | 2022-12-13 | 801 W STATE ROAD 436 STE 2151, ALTAMONTE SPRINGS, FL, 327143056, US | 801 W STATE ROAD 436 STE 2151, ALTAMONTE SPRINGS, FL, 327143056, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 407-461-9200 |
Authorized person
| Name | MS. CHRISTINA NICHOLE HARVEY |
| Role | OWNER |
| Phone | 4074619200 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113445300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARVEY CHRISTINA N | Agent | 801 West State Road 436, Altamonte Springs, FL, 32714 |
| Name | Role | Address |
|---|---|---|
| HARVEY CHRISTINA N | Chief Executive Officer | 801 West State Road 436, Altamonte Springs, FL, 32714 |
| HAYNES CHARLES ESR. | Chief Executive Officer | 801 West State Road 436, Altamonte Springs, FL, 32714 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-30 | 801 West State Road 436, Suite 2151, Altamonte Springs, FL 32714 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-30 | 801 West State Road 436, Suite 2151, Altamonte Springs, FL 32714 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-30 | 801 West State Road 436, Suite 2151, Altamonte Springs, FL 32714 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-30 |
| Florida Limited Liability | 2021-09-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
