| Entity Name: | SUPPORTIVE COMPANIONS HOME CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Feb 2024 (a year ago) |
| Document Number: | L24000093065 |
| Address: | 2828 PALATINO LANE, TAVARES, FL 32778 |
| Mail Address: | 2828 PALATINO LANE, TAVARES, FL 32778 |
| ZIP code: | 32778 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518703537 | 2024-07-09 | 2024-07-09 | 2828 PALATINO LN, TAVARES, FL, 327785626, US | 2828 PALATINO LN, TAVARES, FL, 327785626, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 352-768-9549 |
Authorized person
| Name | KIRSTON HARLEY |
| Role | OWNER |
| Phone | 3527689549 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 122181600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARLEY, KIRSTON L | Agent | 2828PALATINO LANE, TAVARES, FL 32778 |
| Name | Role | Address |
|---|---|---|
| HARLEY, KIRSTON L | Manager | 2828 PALATINO LANE, TAVARES, FL 32778 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-02-22 |
Date of last update: 08 Feb 2025
Sources: Florida Department of State
