| Entity Name: | SUPREME THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Nov 2005 (19 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: | L05000107511 |
| FEI/EIN Number | 203784713 |
| Address: | 734 BLACK IRONWOOD DRIVE, DELAND, FL, 32724, US |
| Mail Address: | 734 BLACK IRONWOOD DRIVE, DELAND, FL, 32724, US |
| ZIP code: | 32724 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225143647 | 2006-08-19 | 2020-08-22 | 770 KEENELAND PIKE, LAKE MARY, FL, 327463951, US | 770 KEENELAND PIKE, LAKE MARY, FL, 327463951, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 407-321-8833 |
| Fax | 4073229966 |
Authorized person
| Name | MR. JOANNES MARIA CLAESSENS |
| Role | MANAGING MEMBER |
| Phone | 4073218833 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT16865 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT215 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | Y066A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLAESSENS JON M | Agent | 734 BLACK IRONWOOD DRIVE, DELAND, FL, 32724 |
| Name | Role | Address |
|---|---|---|
| CLAESSENS JON M | Managing Member | 734 BLACK IRONWOOD DRIVE, DELAND, FL, 32724 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| LC AMENDMENT | 2021-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-27 | 734 BLACK IRONWOOD DRIVE, DELAND, FL 32724 | No data |
| CHANGE OF MAILING ADDRESS | 2021-09-27 | 734 BLACK IRONWOOD DRIVE, DELAND, FL 32724 | No data |
| LC AMENDMENT | 2017-06-02 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-14 | 734 BLACK IRONWOOD DRIVE, DELAND, FL 32724 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-01-19 | CLAESSENS, JON M | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-01-24 |
| LC Amendment | 2021-09-27 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-16 |
| LC Amendment | 2017-06-02 |
| ANNUAL REPORT | 2017-01-20 |
| ANNUAL REPORT | 2016-01-27 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
