| Entity Name: | HEALTHSOURCE OF NORTHWEST FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Feb 2007 (18 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 31 Dec 2012 (12 years ago) |
| Document Number: | L07000021353 |
| FEI/EIN Number | 208514841 |
| Address: | 1090 Scenic Hwy., Pensacola, FL, 32503, US |
| Mail Address: | 1090 Scenic Hwy., Pensacola, FL, 32503, US |
| ZIP code: | 32503 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104015866 | 2007-10-18 | 2022-07-21 | 2122 W NINE MILE RD, PENSACOLA, FL, 325349464, US | 2122 W NINE MILE RD, PENSACOLA, FL, 325349464, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-473-5555 |
| Fax | 8504735505 |
Authorized person
| Name | DR. JASON D RABINOWITZ |
| Role | OWNER CHIROPRACTOR |
| Phone | 8504735555 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH7205 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH9112 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH11561 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH11826 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | CH12186 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | BM255A |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HEALTHSOURCE OF NORTHWEST FLORIDA 401(K) PLAN | 2023 | 208514841 | 2024-10-15 | HEALTHSOURCE OF NORTHWEST FLORIDA, LLC | 11 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-15 |
| Name of individual signing | ALEXA GAY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| RABINOWITZ JASON D | Agent | 2740 BANQUOS TRAIL, PENSACOLA, FL, 32503 |
| Name | Role | Address |
|---|---|---|
| RABINOWITZ JASON D | Manager | 2740 BANQUOS TRAIL, PENSACOLA, FL, 32503 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000036974 | INJURY HELPLINE FLORIDA | ACTIVE | 2024-03-13 | 2029-12-31 | No data | 1090 SCENIC HWY, PENSACOLA, FL, 32503 |
| G19000039501 | HEALTHSOURCE OF PACE | ACTIVE | 2019-03-27 | 2029-12-31 | No data | 1090 SCENIC HWY, PENSACOLA, FL, 32503 |
| G19000039502 | HEALTHSOURCE OF PENSACOLA | ACTIVE | 2019-03-27 | 2029-12-31 | No data | 1090 SCENIC HWY., PENSACOLA, FL, 32503 |
| G19000039504 | HEALTHSOURCE OF NINE MILE | ACTIVE | 2019-03-27 | 2029-12-31 | No data | 1090 SCENIC HWY, PENSACOLA, FL, 32503 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-04 | 1090 Scenic Hwy., Pensacola, FL 32503 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-04 | 1090 Scenic Hwy., Pensacola, FL 32503 | No data |
| LC NAME CHANGE | 2012-12-31 | HEALTHSOURCE OF NORTHWEST FLORIDA, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-01-31 | 2740 BANQUOS TRAIL, PENSACOLA, FL 32503 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-02-10 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-03-04 |
| ANNUAL REPORT | 2020-04-22 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-03-15 |
| AMENDED ANNUAL REPORT | 2016-06-02 |
| ANNUAL REPORT | 2016-02-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
