| Entity Name: | GROTTO MEDCLUB LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 May 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 22 Nov 2016 (8 years ago) |
| Document Number: | L15000093842 |
| FEI/EIN Number | 47-4635107 |
| Address: | 333 SOUTHERN BLVD,, SUITE 404, West Palm Beach, FL, 33405, US |
| Mail Address: | 333 Southern Blvd, West Palm Beach, FL, 33405, US |
| ZIP code: | 33405 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821505215 | 2018-01-07 | 2018-01-07 | 224 DATURA ST STE 315, WEST PALM BEACH, FL, 334015631, US | 224 DATURA ST STE 315, WEST PALM BEACH, FL, 334015631, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 561-214-3323 |
Authorized person
| Name | ZAQUERI WAYNE WILSON |
| Role | PRACTICE MANAGER/CO-OWNER |
| Phone | 5612143323 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPPES |
| Number | 1598081416 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILSON ZAQUERI W | Agent | 333 SOUTHERN BLVD,, West Palm Beach, FL, 33405 |
| Name | Role | Address |
|---|---|---|
| GUTHRIE JENNIFER Dr. | Manager | 333 Southern Blvd, West Palm Beach, FL, 33405 |
| WILSON ZAQUERI | Manager | 333 Southern Blvd, West Palm Beach, FL, 33405 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000016476 | MEDCLUB BY DR. JENN | ACTIVE | 2016-02-15 | 2026-12-31 | No data | 333 SOUTHERN BLVD, 404, WEST PALM BEACH, FL, 33405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-15 | 333 SOUTHERN BLVD,, SUITE 404, West Palm Beach, FL 33405 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-01 | 333 SOUTHERN BLVD,, SUITE 404, West Palm Beach, FL 33405 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-06-17 | 333 SOUTHERN BLVD,, SUITE 404, West Palm Beach, FL 33405 | No data |
| REINSTATEMENT | 2016-11-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-11-22 | WILSON, ZAQUERI W | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-04-14 |
| ANNUAL REPORT | 2021-02-06 |
| ANNUAL REPORT | 2020-04-01 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-13 |
| ANNUAL REPORT | 2017-01-11 |
| REINSTATEMENT | 2016-11-22 |
| Florida Limited Liability | 2015-05-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
