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SOURCE OF LIFE CARE LLC - Florida Company Profile

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Company Details

Entity Name: SOURCE OF LIFE CARE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 14 Apr 2023 (2 years ago)
Document Number: L23000184884
FEI/EIN Number 92-3494765
Address: 12823 138TH LANE, LARGO, FL, 33774
Mail Address: 12823 138th Ln, Largo, FL, 33774, US
ZIP code: 33774
City: Largo
County: Pinellas
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
WANYANDWE PERPETUE W Authorized Member 12823 138TH LANE, LARGO, FL, 33774
SIMON MARGARET A Agent 500 N Willow Ave, TAMPA, FL, 33606

National Provider Identifier

NPI Number:
1528840279
Certification Date:
2023-10-17

Authorized Person:

Name:
PERPETUE WANYANDWE
Role:
ADMINISTRATOR
Phone:

Taxonomy:

Selected Taxonomy:
251E00000X - Home Health Agency
Is Primary:
Yes

Contacts:

Fax:
3862005982

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-04-30 12823 138TH LANE, LARGO, FL 33774 -
REGISTERED AGENT ADDRESS CHANGED 2024-04-30 3314 HENDERSON BLVD, STE 100P, TAMPA, FL 33609 -

Documents

Name Date
ANNUAL REPORT 2024-04-30
Florida Limited Liability 2023-04-14

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Date of last update: 02 Aug 2025

Sources: Florida Department of State