| Entity Name: | SPRUCE CREEK MENTAL HEALTH SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Jan 2013 (12 years ago) |
| Document Number: | L13000001579 |
| FEI/EIN Number | 46-1680921 |
| Address: | 6117 Del Rio Drive, PORT ORANGE, FL, 32127, US |
| Mail Address: | 6117 Del Rio Drive, PORT ORANGE, FL, 32127, US |
| ZIP code: | 32127 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669710273 | 2013-01-17 | 2013-02-01 | 6112 PALMAS DR, PORT ORANGE, FL, 321276751, US | 1690 DUNLAWTON AVE, SUITE 125, PORT ORANGE, FL, 321278979, US | |||||||||||||||||||
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| Phone | +1 386-681-8639 |
| Fax | 3863103992 |
Authorized person
| Name | MR. EDWARD C KING |
| Role | OWNER |
| Phone | 3866818639 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| License Number | SW10520 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KING EDWARD | Agent | 6117 Del Rio Drive, PORT ORANGE, FL, 32127 |
| Name | Role | Address |
|---|---|---|
| KING SHANNON | Managing Member | 164 Avocet Court, Daytona Beach, FL, 32119 |
| KING EDWARD | Managing Member | 6117 del Rio Drive, PORT ORANGE, FL, 32127 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000130006 | SPRUCE CREEK COUNSELING SERVICES | EXPIRED | 2014-12-26 | 2019-12-31 | No data | 6112 PALMAS DRIVE, PORT ORANGE, FL, 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-22 | 1690 Dunlawton Ave, Suite 125, PORT ORANGE, FL 32127 | No data |
| CHANGE OF MAILING ADDRESS | 2025-01-22 | 1690 Dunlawton Ave, Suite 125, PORT ORANGE, FL 32127 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-22 | 1690 Dunlawton Ave, Suite 125, PORT ORANGE, FL 32127 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-04 | 6117 Del Rio Drive, PORT ORANGE, FL 32127 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-04 | 6117 Del Rio Drive, PORT ORANGE, FL 32127 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-04 | 6117 Del Rio Drive, PORT ORANGE, FL 32127 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-22 |
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-04 |
| ANNUAL REPORT | 2022-03-02 |
| ANNUAL REPORT | 2021-04-15 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-03-08 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-04-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
