| Entity Name: | KHASHABA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Apr 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 05 Oct 2021 (3 years ago) |
| Document Number: | L15000071929 |
| FEI/EIN Number | 47-3842855 |
| Address: | 297 HIGHWAY A1A, 311, SATELLITE BEACH, FL, 32937, US |
| Mail Address: | 297 HIGHWAY A1A, 311, SATELLITE BEACH, FL, 32937, US |
| ZIP code: | 32937 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215435870 | 2018-01-30 | 2020-11-17 | 250 N WICKHAM RD, MELBOURNE, FL, 329358625, US | 250 N WICKHAM RD, MELBOURNE, FL, 329358625, US | |||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-752-1571 |
| Phone | +1 321-752-1517 |
Authorized person
| Name | OMAR A KASHABA |
| Role | OWNER |
| Phone | 2018888250 |
Taxonomy
| Taxonomy Code | 208M00000X - Hospitalist Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | JH488A |
| State | FL |
| Issuer | MEDICAID |
| Number | 024500900 |
| State | FL |
| Issuer | MEDICARE - FL |
| Number | FY303T |
| State | FL |
| Issuer | RRMEDICARE PTAN |
| Number | DY1649 |
| State | FL |
| Issuer | MEDICAID |
| Number | 004665600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KHASHABA OMAR | Agent | 297 HIGHWAY A1A, SATELLITE BEACH, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| KHASHABA OMAR A | Authorized Member | 297 HIGHWAY A1A, SATELLITE BEACH, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-29 | 297 HIGHWAY A1A, 311, SATELLITE BEACH, FL 32937 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-29 | 297 HIGHWAY A1A, 311, SATELLITE BEACH, FL 32937 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-29 | 297 HIGHWAY A1A, 311, SATELLITE BEACH, FL 32937 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-21 | KHASHABA, OMAR | No data |
| REINSTATEMENT | 2016-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-07-21 |
| REINSTATEMENT | 2021-10-05 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-02-21 |
| ANNUAL REPORT | 2018-04-20 |
| ANNUAL REPORT | 2017-02-15 |
| REINSTATEMENT | 2016-10-25 |
| Florida Limited Liability | 2015-04-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
