| Entity Name: | LIFE CARE DIABETIC SUPPLIES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 Aug 1999 (25 years ago) |
| Date of dissolution: | 23 Dec 2014 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 Dec 2014 (10 years ago) |
| Document Number: | P99000076276 |
| FEI/EIN Number | 650943447 |
| Address: | 840 JUPITER PARK DRIVE, SUITE 101, JUPITER, FL, 33458, US |
| Mail Address: | PO BOX 641, JUPITER, FL, 33468 |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1689621393 | 2006-05-28 | 2014-06-30 | PO BOX 641, JUPITER, FL, 334680641, US | 840 JUPITER PARK DR, SUITE 101, JUPITER, FL, 334588947, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 561-745-7338 |
| Fax | 5614276427 |
| Phone | +1 561-745-7335 |
Authorized person
| Name | MRS. BIBY DAVILA JACOBY |
| Role | PRESIDENT |
| Phone | 5617457338 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | 1312919 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 567602 |
| State | IA |
| Issuer | MEDICAID |
| Number | 000326697C |
| State | GA |
| Issuer | MEDICAID |
| Number | 90011446 |
| State | KY |
| Issuer | MEDICAID |
| Number | 143776601 |
| State | TX |
| Issuer | MEDICAID |
| Number | 200304520A |
| State | KS |
| Issuer | MEDICAID |
| Number | 200008430A |
| State | OK |
| Issuer | MEDICAID |
| Number | 9982460 |
| State | AL |
| Issuer | MEDICAID |
| Number | 7821760 |
| State | NM |
| Issuer | MEDICAID |
| Number | 845265155 |
| State | ID |
| Issuer | HME LICENSE |
| Number | 1312919 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1469017 |
| State | LA |
| Issuer | MEDICAID |
| Number | 031242800 |
| State | FL |
| Issuer | MEDICAID |
| Number | 401094900 |
| State | MD |
| Issuer | MEDICAID |
| Number | 443086700 |
| State | MI |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LIFE CARE 401(K) | 2012 | 650943447 | 2013-09-18 | LIFE CARE DIABETIC SUPPLIES, INC | 15 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2013-09-18 |
| Name of individual signing | SARA LASSANDRO |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| JACOBY BIBY D | Agent | 840 JUPITER PARK DRIVE, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| JACOBY BIBY D | President | 840 JUPITER PARK DR, SUITE 101, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| WOODARD JOLIE Y | OPER | 840 JUPITER PARK DR, SUITE 101, JUPITER, FL, 33458 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000120555 | LIFE CARE UROLOGICAL | EXPIRED | 2013-12-10 | 2018-12-31 | No data | P.O. BOX 641, JUPITER, FL, 33468 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-02-24 | 840 JUPITER PARK DRIVE, SUITE 101, JUPITER, FL 33458 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-24 | 840 JUPITER PARK DRIVE, SUITE 101, JUPITER, FL 33458 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-29 | 840 JUPITER PARK DRIVE, SUITE 101, JUPITER, FL 33458 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-23 |
| ANNUAL REPORT | 2014-02-24 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-04-16 |
| ANNUAL REPORT | 2011-12-02 |
| ANNUAL REPORT | 2011-02-04 |
| ANNUAL REPORT | 2010-03-02 |
| ANNUAL REPORT | 2009-04-13 |
| ANNUAL REPORT | 2008-04-23 |
| ANNUAL REPORT | 2007-01-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
