| Entity Name: | JSK JSN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 20 Mar 2015 (10 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L15000050646 |
| FEI/EIN Number | 473502892 |
| Address: | 14807 East Colonial Drive, Suite # 112, Orlando, FL, 32826, US |
| Mail Address: | 3312 Bromley Lane, Aurora, IL, 60502, US |
| ZIP code: | 32826 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437531308 | 2015-06-26 | 2016-06-22 | 14807 E COLONIAL DR, SUITE 112, ORLANDO, FL, 328265122, US | 14807 E COLONIAL DR, SUITE 112, ORLANDO, FL, 328265122, US | |||||||||||||||||||||
|
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| Phone | +1 321-289-1951 |
| Phone | +1 407-250-6742 |
Authorized person
| Name | DR. KAUSHIKKUMAR K. PATEL |
| Role | DOCTOR |
| Phone | 3212891951 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 17451100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAYLESS TOBY | Agent | 3312 Bromley Lane, Aurora, FL, 60502 |
| Name | Role | Address |
|---|---|---|
| Prime Care Consulting & Managment LLC | Manager | 3312 Bromley Lane, Aurora, IL, 60502 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000087094 | ALAFAYA MEDICAL WALK IN CLINIC | EXPIRED | 2015-08-23 | 2020-12-31 | No data | 3 INDIAN RIVER, SUITE 1201, TITUSVILLE, FL, 32796 |
| G15000030454 | AVALON MEDICAL WALK IN CLINIC | EXPIRED | 2015-03-24 | 2020-12-31 | No data | 3595 RANEY ROAD, TITUSVILLE, FL, 32780 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-14 | 3312 Bromley Lane, Aurora, FL 60502 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-14 | 14807 East Colonial Drive, Suite # 112, Orlando, FL 32826 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-14 | 14807 East Colonial Drive, Suite # 112, Orlando, FL 32826 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-14 | BAYLESS, TOBY | No data |
| REINSTATEMENT | 2016-12-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2015-07-20 | No data | No data |
| LC AMENDMENT | 2015-04-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-02-09 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-02-10 |
| REINSTATEMENT | 2016-12-01 |
| LC Amendment | 2015-07-20 |
| LC Amendment | 2015-04-15 |
| Florida Limited Liability | 2015-03-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
