| Entity Name: | LIGHTHOUSE HOME CARE INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 29 Jan 2024 (a year ago) |
| Document Number: | P24000008150 |
| FEI/EIN Number | 99-1087309 |
| Address: | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 |
| Mail Address: | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578774543 | 2007-05-24 | 2008-08-13 | 1805 S 25TH ST STE B, FORT PIERCE, FL, 349474752, US | 1805 S 25TH ST STE B, FORT PIERCE, FL, 349474752, US | |||||||||||||||||||||||||
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| Phone | +1 772-466-9199 |
| Fax | 7724664776 |
Authorized person
| Name | MRS. CHRYSTAL BAKER FASSOLD |
| Role | ADMINISTRATOR |
| Phone | 7724669199 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | NR30211217 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 688593498 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VALLEJO, SHELBY N | Agent | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 |
| Name | Role | Address |
|---|---|---|
| ALL ROOFING & CONSTRUCTION CO., INC. | Vice President | 1490 W STATE RD 434, 108 LONGWOOD, FL 32750 |
| Name | Role | Address |
|---|---|---|
| VALLEJO, SHELBY N | Chief Executive Officer | 1290 EASTLAND POINT, LONGWOOD, FL 32750 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-20 | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-20 | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-20 | 1490 W STATE ROAD 434, 108, LONGWOOD, FL 32750 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| Domestic Profit | 2024-01-29 |
Date of last update: 09 Feb 2025
Sources: Florida Department of State
