| Entity Name: | EARLY INTERVENTION SPECIALISTS OF NORTHWEST FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
EARLY INTERVENTION SPECIALISTS OF NORTHWEST FLORIDA, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 07 Mar 2013 (12 years ago) |
| Date of dissolution: | 25 Sep 2015 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (10 years ago) |
| Document Number: | L13000034848 |
| FEI/EIN Number |
46-2214164
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 5170 12TH AVE, MALONE, FL, 32445 |
| Mail Address: | 5170 12TH AVE, MALONE, FL, 32445 |
| ZIP code: | 32445 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063753572 | 2013-03-07 | 2013-03-07 | 5170 12TH AVE, MALONE, FL, 324453426, US | 5170 12TH AVE, MALONE, FL, 324453426, US | |||||||||||||||||||||||||
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| Phone | +1 850-209-5880 |
| Fax | 8665214620 |
Authorized person
| Name | MARCIA S THOMPSON |
| Role | OWNER |
| Phone | 8502095880 |
Taxonomy
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| License Number | RN3076242 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 810941900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| THOMPSON MARCIA S | Managing Member | 5170 12TH AVE, MALONE, FL, 32445 |
| THOMPSON MARCIA S | Agent | 5170 12TH AVE, MALONE, FL, 32445 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-12-01 | 5170 12TH AVE, MALONE, FL 32445 | - |
| CHANGE OF MAILING ADDRESS | 2025-12-01 | 5170 12TH AVE, MALONE, FL 32445 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-01 | 5170 12TH AVE, MALONE, FL 32445 | - |
| CHANGE OF MAILING ADDRESS | 2024-12-01 | 5170 12TH AVE, MALONE, FL 32445 | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-01-11 |
| Florida Limited Liability | 2013-03-07 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
