| Entity Name: | AXIOMHEALTH MANAGEMENT LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Apr 2016 (9 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 21 Jun 2022 (3 years ago) |
| Document Number: | L16000072701 |
| FEI/EIN Number | 81-2412225 |
| Address: | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 |
| Mail Address: | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912456799 | 2016-09-22 | 2024-10-22 | 1180 SPRING CENTRE SOUTH BLVD STE 225, ALTAMONTE SPRINGS, FL, 327141991, US | 1180 SPRING CENTRE SOUTH BLVD STE 225, ALTAMONTE SPRINGS, FL, 327141991, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-495-1165 |
| Fax | 4074940644 |
| Phone | +1 407-494-0644 |
Authorized person
| Name | MR. DUSTIN PATRIC MOURA |
| Role | REGISTERED AGENT |
| Phone | 4073888866 |
Taxonomy
| Taxonomy Code | 207P00000X - Emergency Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| Is Primary | No |
| Taxonomy Code | 224Z00000X - Occupational Therapy Assistant |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 2251G0304X - Geriatric Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 225200000X - Physical Therapy Assistant |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019968100 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AXIOMHEALTH MANAGEMENT LLC 401(K) PLAN. | 2023 | 812412225 | 2024-09-30 | AXIOMHEALTH MANAGEMENT LLC | 27 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-30 |
| Name of individual signing | VICKI PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-08-15 |
| Business code | 621610 |
| Sponsor’s telephone number | 4704335008 |
| Plan sponsor’s address | 1180 SPRING CENTRE S BLVD STE, ALTAMONTE SPRINGS, FL, 32714 |
Signature of
| Role | Plan administrator |
| Date | 2023-10-03 |
| Name of individual signing | VICKI PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2023-10-03 |
| Name of individual signing | VICKI PAGE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MOURA, DUSTIN | Agent | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 |
| Name | Role | Address |
|---|---|---|
| Moura, Dustin | Managing Partner | 1180 Spring Centre South Blvd, Suite 225 Altamonte Springs, FL 32714 |
| Name | Role | Address |
|---|---|---|
| Moura, Deborah | Partner | 1180 Spring Centre South Blvd, Suite 225 Altamonte Springs, FL 32714 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000025990 | AXIOM HEALTH SOLUTIONS | EXPIRED | 2017-03-10 | 2022-12-31 | No data | 155 CRANES ROOST BLVD, ALTAMONTE SPRINGS, FL, 32701 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2022-06-21 | AXIOMHEALTH MANAGEMENT LLC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-25 | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-25 | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-25 | 1180 Spring Centre South Blvd, Suite 225, Altamonte Springs, FL 32714 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-19 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-05-03 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-03-16 |
| Florida Limited Liability | 2016-04-14 |
Date of last update: 20 Jan 2025
Sources: Florida Department of State
