| Entity Name: | INDEPENDENCE LIVING SOLUTIONS INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Sep 2011 (13 years ago) |
| Document Number: | P11000085898 |
| FEI/EIN Number | 453593840 |
| Address: | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073, US |
| Mail Address: | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073, US |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669861217 | 2015-01-21 | 2015-01-21 | 2822 SPOONBILL TRL, ORANGE PARK, FL, 320731654, US | 2822 SPOONBILL TRL, ORANGE PARK, FL, 320731654, US | |||||||||||||||||||||||||
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| Phone | +1 904-374-1722 |
Authorized person
| Name | MR. TAMBA NGAUJA |
| Role | EXECUTIVE DIRECTOR |
| Phone | 9043741722 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012283500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 004282900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NGAUJA TAMBA | Agent | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| NGAUJA TAMBA | President | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| NGAUJA TAMBA | Director | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073 |
| Ngauja SIA | Director | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| NGAUJA KADIATU | Secretary | 2822 SPOONBILL TRAIL, ORANGE PARK, FL, 32073 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-02 |
| ANNUAL REPORT | 2023-03-25 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-03-17 |
| AMENDED ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2020-01-12 |
| ANNUAL REPORT | 2019-03-17 |
| ANNUAL REPORT | 2018-02-21 |
| ANNUAL REPORT | 2017-03-15 |
| ANNUAL REPORT | 2016-03-04 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
