| Entity Name: | ICONIC HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Apr 2016 (9 years ago) |
| Document Number: | L16000082742 |
| FEI/EIN Number | 81-2674216 |
| Address: | 1898 W HILLSBORO BLVD, DEERFIELD BEACH, FL, 33442, US |
| Mail Address: | 1898 W HILLSBORO BLVD, DEERFIELD BEACH, FL, 33442, US |
| ZIP code: | 33442 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700460383 | 2021-05-10 | 2021-05-19 | 1898 W HILLSBORO BLVD STE H, DEERFIELD BEACH, FL, 334421434, US | 1898 W HILLSBORO BLVD STE H, DEERFIELD BEACH, FL, 334421434, US | |||||||||||||||||||||||
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| Phone | +1 954-571-9392 |
| Fax | 9542894888 |
Authorized person
| Name | SARAH RAVELLI |
| Role | CEO, LEAD PRACTITIONER |
| Phone | 3302771131 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| RAVELLI SARAH EARNP-C | Agent | 4605 Rothschild Drive, Coral Springs, FL, 33067 |
| Name | Role | Address |
|---|---|---|
| KLINGER T A | Owner | 4605 ROTHSCHILD DRIVE, CORAL SPRINGS, FL, 33067 |
| RAVELLI SARAH E | Owner | 4605 ROTHSCHILD DRIVE, CORAL SPRINGS, FL, 33067 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000154572 | ICONIC HEALTH & HYPERBARICS | ACTIVE | 2021-11-18 | 2026-12-31 | No data | 1898 W HILLSBORO BLVD STE H, DEERFIELD BEACH, FL, 33442 |
| G21000068323 | AVID HYPERBARICS | ACTIVE | 2021-05-19 | 2026-12-31 | No data | 1898 W HILLSBORO BLVD, SUITE H, DEERFIELD BEACH, FL, 33442 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-02-19 | 1898 W HILLSBORO BLVD, SUITE H, DEERFIELD BEACH, FL 33442 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-13 | 1898 W HILLSBORO BLVD, SUITE H, DEERFIELD BEACH, FL 33442 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-02 | 4605 Rothschild Drive, Coral Springs, FL 33067 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-02-19 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-06-02 |
| ANNUAL REPORT | 2019-06-17 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-04-03 |
| Florida Limited Liability | 2016-04-27 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 9885958306 | 2021-01-31 | 0455 | PPP | 4605, Coral Springs, FL, 33067 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Feb 2025
Sources: Florida Department of State
