| Entity Name: | JAI HO LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 18 Aug 2015 (9 years ago) |
| Document Number: | L15000141365 |
| FEI/EIN Number | 474827188 |
| Address: | 3 INDIAN RIVER AVENUE, SUITE 1001, TITUSVILLE, FL, 32796, US |
| Mail Address: | 1663 GEORGIA ST NE STE 500, SUITE 1001, PALM BAY, FL, 32907, US |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609321454 | 2016-08-22 | 2022-11-02 | 1650 SAND LAKE RD, SUITE 112A, ORLANDO, FL, 328097681, US | 1650 SAND LAKE RD STE 112A, ORLANDO, FL, 328097671, US | |||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-286-1829 |
| Fax | 4072863291 |
Authorized person
| Name | KANTILAL BHALANI |
| Role | PHYSICIA |
| Phone | 4072861829 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 207QA0401X - Addiction Medicine (Family Medicine) Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RA0401X - Addiction Medicine (Internal Medicine) Physician |
| License Number | ME39710 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207V00000X - Obstetrics & Gynecology Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016834700 |
| State | FL |
| Issuer | NPI NUMBER |
| Number | 1609321454 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BHALANI GITABEN | Agent | 3 INDIAN RIVER AVENUE, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| BHALANI GITABEN | Manager | 3 INDIAN RIVER AVENUE SUITE 1001, TITUSVILLE, FL, 32796 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000091586 | AFFORDABLE CARE CLINICS | ACTIVE | 2023-08-05 | 2028-12-31 | No data | 1663 GEORGIA ST NE STE 500, PALM BAY, FL, 32907 |
| G16000066165 | SANDLAKE MEDICAL WALK IN CLINIC | ACTIVE | 2016-07-05 | 2026-12-31 | No data | 1650 W SAND LAKE RD, SUITE 112-A, ORLANDO, FL, 32809 |
| G15000090453 | MALABAR MEDICAL WALK IN CLINIC | ACTIVE | 2015-09-02 | 2025-12-31 | No data | 1663 GEORGIA. ST. UNIT 500, PALM BAY, FL, 32907 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-28 | 3 INDIAN RIVER AVENUE, SUITE 1001, TITUSVILLE, FL 32796 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-14 | 3 INDIAN RIVER AVENUE, SUITE 1001, TITUSVILLE, FL 32796 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-14 | 3 INDIAN RIVER AVENUE, SUITE 1001, TITUSVILLE, FL 32796 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-03-01 |
| ANNUAL REPORT | 2022-03-06 |
| ANNUAL REPORT | 2021-03-25 |
| ANNUAL REPORT | 2020-01-26 |
| ANNUAL REPORT | 2019-01-27 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-04-16 |
| ANNUAL REPORT | 2016-04-14 |
| Florida Limited Liability | 2015-08-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
