| Entity Name: | SERENITY COMPANION SERVICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Aug 2007 (18 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Feb 2015 (10 years ago) |
| Document Number: | P07000089320 |
| FEI/EIN Number | 260565048 |
| Address: | 116 SOUTH MAGNOLIA AVENUE, OCALA, FL, 34472, US |
| Mail Address: | 15 FIR TRAIL COURSE, OCALA, FL, 34472, US |
| ZIP code: | 34472 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013366939 | 2016-06-10 | 2017-01-04 | 15 FIR TRAIL CRSE, OCALA, FL, 344724220, US | 116 S MAGNOLIA AVE, SUITE 3D, OCALA, FL, 344711178, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 352-348-3509 |
| Fax | 1800372701 |
Authorized person
| Name | MS. LAVETTE GULLEY |
| Role | OWNER |
| Phone | 3523483509 |
Taxonomy
| Taxonomy Code | 106S00000X - Behavior Technician |
| License Number | 231201 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 231201 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 231201 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 305R00000X - Preferred Provider Organization |
| License Number | 231201 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 385HR2060X - Child Intellectual and/or Developmental Disabilities Respite Care |
| License Number | 231201 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000565902 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MALONEY LADASHAZIA D | Agent | 15 FIR TRAIL COURSE, OCALA, FL, 34472 |
| Name | Role | Address |
|---|---|---|
| GULLEY LAVETTE D | Manager | 15 FIR TRAIL COURSE, OCALA, FL, 34472 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-04-18 | MALONEY, LADASHAZIA D | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-06-02 | 15 FIR TRAIL COURSE, OCALA, FL 34472 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-06-02 | 116 SOUTH MAGNOLIA AVENUE, 3D, OCALA, FL 34472 | No data |
| CHANGE OF MAILING ADDRESS | 2017-06-02 | 116 SOUTH MAGNOLIA AVENUE, 3D, OCALA, FL 34472 | No data |
| REINSTATEMENT | 2015-02-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REINSTATEMENT | 2012-11-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-04-02 |
| ANNUAL REPORT | 2018-01-28 |
| ANNUAL REPORT | 2017-06-02 |
| ANNUAL REPORT | 2016-03-30 |
| REINSTATEMENT | 2015-02-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
