| Entity Name: | OPTIMA NEUROLOGICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Dec 2008 (16 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | L08000115749 |
| FEI/EIN Number | 263835938 |
| Address: | 5318 SW 91ST TERRACE, SUITE B, GAINESVILLE, FL, 32608 |
| Mail Address: | 5318 SW 91ST TERRACE, SUITE B, GAINESVILLE, FL, 32608 |
| ZIP code: | 32608 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194950949 | 2009-05-22 | 2009-05-22 | 5318 SW 91ST TER, SUITE B, GAINESVILLE, FL, 326088125, US | 5318 SW 91ST TER, SUITE B, GAINESVILLE, FL, 326088125, US | |||||||||||||||||||||||||
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| Phone | +1 352-375-5553 |
| Fax | 3525055506 |
Authorized person
| Name | JAMES CHRIS SACKELLARES |
| Role | CHIEF MEDICAL OFFICER |
| Phone | 3523755553 |
Taxonomy
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| License Number | ME0072689 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 373950300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SACKELLARES JAMES C | Agent | 9841 SW 55TH ROAD, GAINESVILLE, FL, 32608 |
| Name | Role | Address |
|---|---|---|
| SACKELLARES JAMES C | Manager | 9841 SW 55TH ROAD, GAINESVILLE, FL, 32608 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-21 |
| ANNUAL REPORT | 2010-04-30 |
| ANNUAL REPORT | 2009-04-24 |
| Florida Limited Liability | 2008-12-22 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
