| Entity Name: | A SUNCOAST LIFE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Dec 2020 (4 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P21000000091 |
| FEI/EIN Number | 85-4357462 |
| Address: | 2055 Siesta Drive, Sarasota, FL, 34239, US |
| Mail Address: | 2055 Siesta Drive, Sarasota, FL, 34239, US |
| ZIP code: | 34239 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306436159 | 2021-01-25 | 2021-01-25 | 1100 E BAY DR # G-78, LARGO, FL, 337702541, US | 1100 E BAY DR # G-78, LARGO, FL, 337702541, US | |||||||||||||||||||
|
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| Phone | +1 239-888-3111 |
Authorized person
| Name | JOHNATHAN ERIC FOURTHMAN |
| Role | PRESIDENT/OWNER |
| Phone | 2398883111 |
Taxonomy
| Taxonomy Code | 171M00000X - Case Manager/Care Coordinator |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1689090979 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FOURTHMAN JOHNATHAN E | Agent | 2055 Siesta Drive, Sarasota, FL, 34239 |
| Name | Role | Address |
|---|---|---|
| FOURTHMAN JOHNATHAN E | President | 2055 Siesta Drive, Sarasota, FL, 34239 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-19 | 2055 Siesta Drive, #5434, Sarasota, FL 34239 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-19 | 2055 Siesta Drive, #5434, Sarasota, FL 34239 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-19 | 2055 Siesta Drive, #5434, Sarasota, FL 34239 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-19 |
| Domestic Profit | 2020-12-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
