| Entity Name: | DR. JEREMY GRUNFELD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 03 Feb 2016 (9 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 31 Oct 2017 (7 years ago) |
| Document Number: | L16000023379 |
| FEI/EIN Number | 81-1332631 |
| Address: | 4800 N Federal Highway, BOCA RATON, FL, 33431, US |
| Mail Address: | 4800 N Federal Highway, BOCA RATON, FL, 33431, US |
| ZIP code: | 33431 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053029876 | 2022-11-10 | 2022-11-10 | 7301 W PALMETTO PARK RD STE 105B, BOCA RATON, FL, 334333455, US | 7301 W PALMETTO PARK RD STE 105B, BOCA RATON, FL, 334333455, US | |||||||||||||||||||||
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| Phone | +1 561-717-0960 |
| Fax | 5617173043 |
Authorized person
| Name | DR. JEREMY GRUNFELD |
| Role | OWNER |
| Phone | 5612718768 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103496700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRUNFELD JEREMY | Agent | 4800 N. Federal Highway. D106, Boca Raton, FL, 33431 |
| Name | Role | Address |
|---|---|---|
| PH. D JEREMY G | Managing Member | 4800 N. FEDERAL HIGHWAY. D106, BOCA RATON, FL, 33431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-06 | 4800 N. Federal Highway. D106, D106, Boca Raton, FL 33431 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-14 | 4800 N Federal Highway, BOCA RATON, FL 33431 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-14 | 4800 N Federal Highway, BOCA RATON, FL 33431 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-29 | 2662 Country Lake Trail, Boynton Beach, FL 33436 | No data |
| LC AMENDMENT | 2017-10-31 | No data | No data |
| LC AMENDMENT | 2017-01-17 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-06 |
| ANNUAL REPORT | 2024-01-03 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-07 |
| ANNUAL REPORT | 2020-01-30 |
| ANNUAL REPORT | 2019-01-05 |
| ANNUAL REPORT | 2018-01-13 |
| LC Amendment | 2017-10-31 |
| LC Amendment | 2017-01-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
