| Entity Name: | SPECTRUM LIFE CARE SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Jan 2001 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 28 Oct 2013 (11 years ago) |
| Document Number: | P01000011699 |
| FEI/EIN Number | 651071644 |
| Address: | 12260 SW 53RD STREET, SUITE # 611, COOPER CITY, FL, 33330 |
| Mail Address: | 12260 SW 53RD STREET, SUITE # 611, COOPER CITY, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508989666 | 2007-04-06 | 2020-09-08 | 12260 SW 53RD ST STE 611, COOPER CITY, FL, 333303320, US | 12260 SW 53RD ST STE 611, COOPER CITY, FL, 333303320, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 954-499-5794 |
| Fax | 9542524844 |
| Fax | 9543091520 |
Authorized person
| Name | JOSEPH CIAVARELLA SR. |
| Role | PRESIDENT |
| Phone | 9544995794 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 228629 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 681078196 |
| State | FL |
| Issuer | MEDICAID |
| Number | 681078198 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SPECTRUM CARE 401K PLAN | 2011 | 651071644 | 2012-07-25 | SPECTRUM LIFE CARE SERVICES, INC. | 24 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 651071644 |
| Plan administrator’s name | SPECTRUM LIFE CARE SERVICES, INC. |
| Plan administrator’s address | 11011 SHERIDAN ST STE 216, COOPER CITY, FL, 33026 |
| Administrator’s telephone number | 9544995794 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-25 |
| Name of individual signing | FRED HAUSMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 9544995794 |
| Plan sponsor’s address | 11011 SHERIDAN STREET SUITE 216, COOPER CITY, FL, 33026 |
Plan administrator’s name and address
| Administrator’s EIN | 651071644 |
| Plan administrator’s name | SPECTRUM LIFE CARE SERVICES, INC. |
| Plan administrator’s address | 11011 SHERIDAN STREET SUITE 216, COOPER CITY, FL, 33026 |
| Administrator’s telephone number | 9544995794 |
Signature of
| Role | Plan administrator |
| Date | 2012-11-29 |
| Name of individual signing | FRED HAUSMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 9544995794 |
| Plan sponsor’s address | 11011 SHERIDAN ST STE 216, COOPER CITY, FL, 33026 |
Plan administrator’s name and address
| Administrator’s EIN | 651071644 |
| Plan administrator’s name | SPECTRUM LIFE CARE SERVICES, INC. |
| Plan administrator’s address | 11011 SHERIDAN ST STE 216, COOPER CITY, FL, 33026 |
| Administrator’s telephone number | 9544995794 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-26 |
| Name of individual signing | FRED HAUSMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2006-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 9544995794 |
| Plan sponsor’s address | 11011 SHERIDAN ST STE 216, COOPER CITY, FL, 33026 |
Plan administrator’s name and address
| Administrator’s EIN | 651071644 |
| Plan administrator’s name | SPECTRUM LIFE CARE SERVICES, INC. |
| Plan administrator’s address | 11011 SHERIDAN ST STE 216, COOPER CITY, FL, 33026 |
| Administrator’s telephone number | 9544995794 |
Signature of
| Role | Plan administrator |
| Date | 2010-07-01 |
| Name of individual signing | FRED HAUSMAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| CIAVARELLA JOSEPH ASR | Agent | 12260 SW 53RD STREET, COOPER CITY, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| CIAVARELLA JOSEPH ASR | Director | 12260 SW 53RD STREET, COOPER CITY, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-09-14 | 12260 SW 53RD STREET, SUITE # 611, COOPER CITY, FL 33330 | No data |
| CHANGE OF MAILING ADDRESS | 2020-09-14 | 12260 SW 53RD STREET, SUITE # 611, COOPER CITY, FL 33330 | No data |
| AMENDMENT | 2013-10-28 | No data | No data |
| AMENDMENT | 2013-01-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-01-02 | CIAVARELLA, JOSEPH A, SR | No data |
| AMENDMENT | 2012-11-29 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-17 | 12260 SW 53RD STREET, SUITE # 611, COOPER CITY, FL 33330 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-26 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-03-17 |
| AMENDED ANNUAL REPORT | 2020-09-14 |
| ANNUAL REPORT | 2020-03-04 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-02-16 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
