| Entity Name: | GIFT OF LIFE COMMUNITY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 Nov 2004 (20 years ago) |
| Date of dissolution: | 07 Feb 2007 (18 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 07 Feb 2007 (18 years ago) |
| Document Number: | P04000159518 |
| FEI/EIN Number | 201919487 |
| Address: | 4437 PARK BOULEVARD, PINELLAS PARK, FL, 33781, US |
| Mail Address: | 288 BEACH DR. NE #12B, ST. PETERSBURG, FL, 33701, US |
| ZIP code: | 33781 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619069200 | 2006-09-29 | 2020-08-22 | 4425 PARK BLVD, PINELLAS PARK, FL, 337813540, US | 4425 PARK BLVD, PINELLAS PARK, FL, 337813540, US | |||||||||||||||||||||||||||||||
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| Phone | +1 727-547-0607 |
Authorized person
| Name | MR. LEE WAYNE SCHARRER |
| Role | EXECUTIVE DIRECTOR |
| Phone | 7275470607 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | VALUE OPTIONS PMHP |
| Number | 550560 |
| State | FL |
| Issuer | AMERIGROUP |
| Number | 281413 |
| State | FL |
| Issuer | UNITED HEALTHCARE |
| Number | 337877 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIS CLIFFORD J | Agent | 288 BEACH DR. NE #12B, ST. PETERSBURG, FL, 33701 |
| Name | Role | Address |
|---|---|---|
| DAVIS CLIFFORD J | President | 288 BEACH DR. NE #12B, ST. PETERSBUR, FL, 33701 |
| Name | Role | Address |
|---|---|---|
| SCHARRER LEE W | Vice President | 1040 FAWN CT., OLDSMAR, FL, 34677 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2007-02-07 | No data | CONVERSION MEMBER. RESULTING CORPORATION WAS L07000015129. CONVERSION NUMBER 700000062857 |
| CHANGE OF MAILING ADDRESS | 2006-04-28 | 4437 PARK BOULEVARD, PINELLAS PARK, FL 33781 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-04-28 | 288 BEACH DR. NE #12B, ST. PETERSBURG, FL 33701 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000158995 | TERMINATED | 1000000125265 | PINELLAS | 2009-06-01 | 2030-02-16 | $ 3,368.39 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CLEARWATER SERVICE CENTER, 19337 US HIGHWAY 19 N STE 200, CLEARWATER FL337643149 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-04-28 |
| ANNUAL REPORT | 2005-04-27 |
| Domestic Profit | 2004-11-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
