| Entity Name: | SUPPORT INDEPENDENT LIVING INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Feb 2003 (22 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P03000020982 |
| FEI/EIN Number | 562515419 |
| Address: | 11 RACETRACK RD, SUITE C2, FORT WALTON BEACH, FL, 32547 |
| Mail Address: | 11 RACETRACK RD, SUITE C2, FORT WALTON BEACH, FL, 32547 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306590260 | 2022-02-09 | 2022-02-09 | 11 RACETRACK RD NE STE C2, FORT WALTON BEACH, FL, 325471867, US | 11 RACETRACK RD NE STE C2, FORT WALTON BEACH, FL, 325471867, US | |||||||||||||||||||||
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| Phone | +1 850-259-7190 |
| Fax | 8508624849 |
Authorized person
| Name | BRENDA F MARRIER |
| Role | OWNER |
| Phone | 8502597190 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 684509696 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARRIER BRENDA | Agent | 2276 SALAMANCA STREET, NAVARRE, FL, 32566 |
| Name | Role | Address |
|---|---|---|
| MARRIER BRENDA | President | 2276 SALAMANCA STREET, NAVARRE, FL, 32566 |
| Name | Role | Address |
|---|---|---|
| MARRIER BRENDA | Director | 2276 SALAMANCA STREET, NAVARRE, FL, 32566 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-14 | 11 RACETRACK RD, SUITE C2, FORT WALTON BEACH, FL 32547 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-14 | 11 RACETRACK RD, SUITE C2, FORT WALTON BEACH, FL 32547 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-15 | 2276 SALAMANCA STREET, NAVARRE, FL 32566 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-05-03 |
| ANNUAL REPORT | 2015-04-16 |
| ANNUAL REPORT | 2014-04-09 |
| ANNUAL REPORT | 2013-04-12 |
| ANNUAL REPORT | 2012-04-30 |
| ANNUAL REPORT | 2011-04-14 |
| ANNUAL REPORT | 2010-04-21 |
| ANNUAL REPORT | 2009-04-15 |
| ANNUAL REPORT | 2008-04-10 |
| ANNUAL REPORT | 2007-04-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
