| Entity Name: | NEUROGENESIS CENTER OF FLORIDA, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Aug 2015 (10 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Jul 2024 (7 months ago) |
| Document Number: | L15000135790 |
| FEI/EIN Number | 47-4779733 |
| Address: | 253 NORTH ORLANDO AVE, SUITE 202, MAITLAND, FL 32751 |
| Mail Address: | 253 NORTH ORLANDO AVE, SUITE 202, MAITLAND, FL 32751 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922474907 | 2015-08-13 | 2021-04-24 | 253 N ORLANDO AVE STE 202, MAITLAND, FL, 327515521, US | 253 N ORLANDO AVE STE 202, MAITLAND, FL, 327515521, US | |||||||||||||||||||
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| Phone | +1 407-790-4101 |
| Fax | 4072774400 |
Authorized person
| Name | AMBER L FASULA |
| Role | OWNER |
| Phone | 4077904101 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| License Number | PY9333 |
| State | FL |
| Is Primary | Yes |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role | Address |
|---|---|---|
| FASULA, AMBER, PSY D | Manager | 253 NORTH ORLANDO AVE, SUITE 202 Maitland, FL 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2024-07-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2024-07-22 | NORTHWEST REGISTERED AGENT LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-07-22 | 7901 4TH ST N, STE 300, ST. PETERSBURG, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-01-02 | 253 NORTH ORLANDO AVE, SUITE 202, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2019-01-02 | 253 NORTH ORLANDO AVE, SUITE 202, MAITLAND, FL 32751 | No data |
| Name | Date |
|---|---|
| CORLCRACHG | 2024-07-22 |
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-01-18 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-03-31 |
| ANNUAL REPORT | 2018-03-12 |
| ANNUAL REPORT | 2017-04-30 |
| ANNUAL REPORT | 2016-04-12 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 7328487200 | 2020-04-28 | 0491 | PPP | 253 N Orlando Ave, Suite 202, Maitland, FL, 32571 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 19 Feb 2025
Sources: Florida Department of State
