| Entity Name: | NEUROLOGY RESTORATION CENTER,LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Nov 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 03 Oct 2018 (6 years ago) |
| Document Number: | L15000195436 |
| FEI/EIN Number | 47-5679326 |
| Address: | 1801 SE HILLMOOR DR, STE A 102, PORT ST LUCIE, FL 34952 |
| Mail Address: | 1801 Southeast Hillmoor Drive, Ste A- 102, Port St. Lucie, FL 34952 |
| ZIP code: | 34952 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043765753 | 2016-08-23 | 2017-10-02 | PO BOX 7938, PORT SAINT LUCIE, FL, 349857938, US | 1701 SE HILLMOOR DR, SUITE D-16, PORT SAINT LUCIE, FL, 349527552, US | |||||||||||||||||||||||||
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| Phone | +1 772-210-1162 |
| Phone | +1 772-201-1162 |
Authorized person
| Name | MS. LUZ G VAZQUEZ |
| Role | OWNER/MD |
| Phone | 7722101162 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME68140 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 257198600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ, LUZ G, MD | Agent | 592 SE Mulberry Way, Port St Lucie, FL 34984 |
| Name | Role | Address |
|---|---|---|
| VAZQUEZ, LUZ G, MD | Authorized Member | 592 SE Mulberry Way, Port St Lucie, FL 34984 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-01-22 | 1801 SE HILLMOOR DR, STE A 102, PORT ST LUCIE, FL 34952 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-21 | 592 SE Mulberry Way, Port St Lucie, FL 34984 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-10-18 | 1801 SE HILLMOOR DR, STE A 102, PORT ST LUCIE, FL 34952 | No data |
| REINSTATEMENT | 2018-10-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-02 | VAZQUEZ, LUZ G, MD | No data |
| REINSTATEMENT | 2017-03-02 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-05 |
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-05-01 |
| REINSTATEMENT | 2018-10-03 |
| REINSTATEMENT | 2017-03-02 |
| Florida Limited Liability | 2015-11-18 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1508207807 | 2020-05-21 | 0455 | PPP | 1801 SE HILLMOOR DR STE A-102, PORT SAINT LUCIE, FL, 34952-7545 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 19 Feb 2025
Sources: Florida Department of State
