| Entity Name: | HELENA WISTON, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 23 Jun 2010 (15 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L10000066712 |
| Address: | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Mail Address: | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| ZIP code: | 33446 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164962528 | 2017-03-06 | 2017-03-06 | 11671 ISLAND LAKES LN, BOCA RATON, FL, 334986802, US | 11671 ISLAND LAKES LN, BOCA RATON, FL, 334986802, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-756-4254 |
Authorized person
| Name | MRS. HELENA WISTON |
| Role | OTR/L |
| Phone | 5617564254 |
Taxonomy
| Taxonomy Code | 225XP0200X - Pediatric Occupational Therapist |
| License Number | OT-6226 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 883426100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 003729800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DEREK WISTON | Agent | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Name | Role | Address |
|---|---|---|
| HELENA WISTON | Managing Member | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Name | Role | Address |
|---|---|---|
| DEREK WISTON | Manager | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000058048 | FUNCTION TIME THERAPY | EXPIRED | 2010-06-23 | 2015-12-31 | No data | 9907 SAVONA WINDS DRIVE, DELRAY BEACH, FL, 33446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Name | Date |
|---|---|
| Florida Limited Liability | 2010-06-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
