| Entity Name: | REVELATIONS TREATMENT CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Apr 2016 (9 years ago) |
| Document Number: | L16000080994 |
| FEI/EIN Number | 81-2433166 |
| Address: | 6780 Eastview Drive, Lake Worth, FL, 33462, US |
| Mail Address: | 6780 Eastview Drive, Lake Worth, FL, 33462, US |
| ZIP code: | 33462 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588114888 | 2016-10-11 | 2016-10-11 | 521 LANTANA RD, LANTANA, FL, 334621625, US | 521 LANTANA RD, LANTANA, FL, 334621625, US | |||||||||||||||||||||||
|
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| Phone | +1 561-360-5050 |
Authorized person
| Name | MS. LORI BETH LONG |
| Role | LICENSED MENTAL HEALTH COUNSELOR |
| Phone | 5613605050 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | MH2035 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | LICENSED MENTAL HEALTH COUNSELOR |
| Number | MH2035 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LONG LORI B | Agent | 6780 Eastview Drive, Lake Worth, FL, 33462 |
| Name | Role | Address |
|---|---|---|
| LONG LORI B | Manager | 6780 Eastview Drive, Lake Worth, FL, 33462 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-05-01 | 6780 Eastview Drive, Lake Worth, FL 33462 | No data |
| CHANGE OF MAILING ADDRESS | 2018-05-01 | 6780 Eastview Drive, Lake Worth, FL 33462 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-05-01 | 6780 Eastview Drive, Lake Worth, FL 33462 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-03-10 |
| ANNUAL REPORT | 2020-05-15 |
| ANNUAL REPORT | 2019-04-28 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-28 |
| Florida Limited Liability | 2016-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
