| Entity Name: | EXCEPTIONAL CARE CHOICE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 07 Jan 2015 (10 years ago) |
| Document Number: | L15000003274 |
| FEI/EIN Number | 47-2823201 |
| Mail Address: | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Address: | 1632 SW Ivy St, Port St Lucie, FL 34987 |
| ZIP code: | 34987 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710365051 | 2015-05-06 | 2017-10-02 | 1632 SW IVY ST, PORT ST LUCIE, FL, 349872248, US | 1632 SW IVY ST, PORT ST LUCIE, FL, 349872248, US | |||||||||||||||||||||||||||
|
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| Phone | +1 917-207-4785 |
Authorized person
| Name | GUSTI LABATTE-DENEAU |
| Role | NURSE PRACTITIONER |
| Phone | 7723339319 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| License Number | ARNP9263802 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016402900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LABATTE-DENEAU, GUSTI | Agent | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Name | Role | Address |
|---|---|---|
| LABATTE-DENEAU, GUSTI | Manager | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Name | Role | Address |
|---|---|---|
| LABATTE-DENEAU, GUSTI | Chief Executive Officer | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Name | Role | Address |
|---|---|---|
| DENEAU, ALIX | Chief Financial Officer | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Name | Role | Address |
|---|---|---|
| DENEAU, ALIX | Authorized Representative | 1632 SW IVY ST, PORT ST LUCIE, FL 34987 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-26 | 1632 SW Ivy St, Port St Lucie, FL 34987 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-26 |
| ANNUAL REPORT | 2023-04-17 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-08-14 |
| ANNUAL REPORT | 2018-08-06 |
| ANNUAL REPORT | 2017-03-19 |
| ANNUAL REPORT | 2016-03-29 |
| Florida Limited Liability | 2015-01-07 |
Date of last update: 21 Jan 2025
Sources: Florida Department of State
