| Entity Name: | INDEPENDENT LIVING WITH CARE ALF, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 11 Jun 2014 (11 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | N14000005579 |
| FEI/EIN Number | 26-1703949 |
| Address: | 3165 SW FAMBROUGH STREET, PORT ST. LUCIE, FL, 34953 |
| Mail Address: | 3165 SW FAMBROUGH STREET, PORT ST. LUCIE, FL, 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679914741 | 2013-07-17 | 2013-07-17 | 3165 SW FAMBROUGH ST, PORT ST LUCIE, FL, 349534541, US | 3165 SW FAMBROUGH ST, PORT ST LUCIE, FL, 349534541, US | |||||||||||||||||||||||||||||||
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| Phone | +1 772-878-1010 |
| Fax | 7723451402 |
Authorized person
| Name | TISA FORTE |
| Role | OWNER |
| Phone | 7728781010 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 11368 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000585500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 000179100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LAMAR TRELLIS | Agent | 3165 SW FAMBROUGH STREET, PORT ST. LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| FORTE TISA D | President | 3165 SW FAMBROUGH STREET, PORT ST LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| FORTE TISA D | Vice President | 3165 SW FAMBROUGH STREET, PORT ST LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| FORTE TISA D | Secretary | 3165 SW FAMBROUGH STREET, PORT ST LUCIE, FL, 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2016-03-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-17 | LAMAR, TRELLIS | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-04 |
| REINSTATEMENT | 2016-03-17 |
| Domestic Non-Profit | 2014-06-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
