| Entity Name: | EVERGREEN LIFE SERVICES OF FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 11 Jul 2019 (6 years ago) |
| Document Number: | N19000007044 |
| FEI/EIN Number | 84-2378514 |
| Mail Address: | 2101 HIGHWAY 80, HAUGHTON, LA, 71037 |
| Address: | 2101 STARKEY ROAD, Q SOUTH, LARGO, FL, 33771 |
| ZIP code: | 33771 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093365215 | 2019-09-19 | 2021-01-27 | 2101 HIGHWAY 80, HAUGHTON, LA, 710379488, US | 2101 STARKEY RD, LARGO, FL, 337715340, US | |||||||||||||||||
|
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| Phone | +1 318-949-5515 |
| Fax | 3189495555 |
| Phone | +1 727-748-6203 |
Authorized person
| Name | MERLON KENT CRAFT |
| Role | EVP/CFO |
| Phone | 3189495515 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BUCHHOLTZ SUSAN M | Agent | 2101 STARKEY RD, LARGO, FL, 33771 |
| Name | Role | Address |
|---|---|---|
| Buchholtz Susan M | President | 2101 Highway 80, Haughton, LA, 71037 |
| Name | Role | Address |
|---|---|---|
| Craft Kent | Vice President | 2101 Highway 80, Haughton, LA, 71037 |
| Name | Role | Address |
|---|---|---|
| EMERSON ERIC | Chairman | 2101 Highway 80, Haughton, LA, 71037 |
| Harding JR | Chairman | 2101 Highway 80, Haughton, LA, 71037 |
| Name | Role | Address |
|---|---|---|
| Kizer Tracy | Secretary | 2101 Highway 80, Haughton, LA, 71037 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-04-08 | BUCHHOLTZ, SUSAN M | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-08 | 2101 STARKEY RD, Q-SOUTH, LARGO, FL 33771 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| AMENDED ANNUAL REPORT | 2023-07-18 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-27 |
| AMENDED ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-02-18 |
| Domestic Non-Profit | 2019-07-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
