| Entity Name: | SOUTH CENTRAL CARE PROVIDER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 19 Feb 2024 (a year ago) |
| Document Number: | L24000086749 |
| Address: | 2797 RECKER HIGHWAY, WINTER HAVEN, FL 33880 |
| Mail Address: | 2797 RECKER HIGHWAY, WINTER HAVEN, FL 33880 |
| ZIP code: | 33880 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255197737 | 2024-02-22 | 2024-02-22 | 2797 RECKER HWY, WINTER HAVEN, FL, 338801940, US | 2797 RECKER HWY, WINTER HAVEN, FL, 338801940, US | |||||||||||||
|
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| Phone | +1 954-805-5488 |
Authorized person
| Name | DIAMOND BELLE |
| Role | QWNER |
| Phone | 9548055488 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BELLE, DIAMOND | Agent | 2797 RECKER HIGHWAY, WINTER HAVEN, FL 33880 |
| Name | Role | Address |
|---|---|---|
| SOUTH CENTRAL CARE PROVIDER LLC | Authorized Member | No data |
| BELLE, DIAMOND | Authorized Member | 2797 RWCKER HIGHWAY, WINTER HAVEN, FL 33880 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-02-19 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
