| Entity Name: | BRAIN SPINE AND SLEEP INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
BRAIN SPINE AND SLEEP INSTITUTE LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 19 Jul 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Apr 2024 (a year ago) |
| Document Number: | L16000135728 |
| FEI/EIN Number |
81-3319008
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1120 Carlton Ave, WINTER HAVEN, FL, 33853, US |
| Mail Address: | 1120 Carlton Ave, WINTER HAVEN, FL, 33853, US |
| ZIP code: | 33853 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386190734 | 2016-08-26 | 2023-03-07 | 1120 CARLTON AVE, SUITE 1300, LAKE WALES, FL, 338534347, US | 1120 CARLTON AVE, SUITE 1300, LAKE WALES, FL, 338534347, US | |||||||||||||||||||||||||||||
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| Phone | +1 863-676-6386 |
| Fax | 8636763124 |
Authorized person
| Name | HASAN M MOUSLI |
| Role | OWNER/MD |
| Phone | 8636766386 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P2900X - Pain Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
| Taxonomy Code | 2084S0012X - Sleep Medicine (Psychiatry & Neurology) Physician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | LICENSE |
| Number | ME97722 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRAIN SPINE AND SLEEP INSTITUTE 401(K) PLAN | 2023 | 813319008 | 2024-05-23 | BRAIN SPINE AND SLEEP INSTITUTE | 3 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-05-23 |
| Name of individual signing | DESTINY BARGER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-05-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8634091362 |
| Plan sponsor’s address | 1120 CARLTON AVE. STE 1300, LAKE WALES, FL, 33853 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-30 |
| Name of individual signing | DESTINY BARGER |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-05-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8634091362 |
| Plan sponsor’s address | 1120 CARLTON AVE. STE 1300, LAKE WALES, FL, 33853 |
Signature of
| Role | Plan administrator |
| Date | 2022-05-26 |
| Name of individual signing | MILCAH CACULITAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-05-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8634091362 |
| Plan sponsor’s address | 1120 CARLTON AVE. STE 1300, LAKE WALES, FL, 33853 |
Signature of
| Role | Plan administrator |
| Date | 2022-04-07 |
| Name of individual signing | MILCAH CACULITAN |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-05-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8634091362 |
| Plan sponsor’s address | 1120 CARLTON AVE. SUITE 1300, LAKE WALES, FL, 33853 |
Signature of
| Role | Plan administrator |
| Date | 2020-10-15 |
| Name of individual signing | MILCAH CACULITAN |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MOUSLI HASAN | Manager | 1120 Carlton Ave, WINTER HAVEN, FL, 33853 |
| Abbas Zeena | Manager | 1120 Carlton Ave, WINTER HAVEN, FL, 33853 |
| MOUSLI HASAN MDr. | Agent | 1120 Carlton Ave, WINTER HAVEN, FL, 33853 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-02-07 | 1120 Carlton Ave, Suite 1300, Lake Wales, FL 33853 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2025-02-07 | 1120 Carlton Ave, Suite 1300, Lake Wales, FL 33853 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2025-02-07 | 1120 Carlton Ave, Suite 1300, Lake Wales, FL 33853 | - |
| REGISTERED AGENT NAME CHANGED | 2024-04-17 | MOUSLI, HASAN M, Dr. | - |
| REINSTATEMENT | 2024-04-17 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 1120 Carlton Ave, Suite 1300, WINTER HAVEN, FL 33853 | - |
| CHANGE OF MAILING ADDRESS | 2020-06-30 | 1120 Carlton Ave, Suite 1300, WINTER HAVEN, FL 33853 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-30 | 1120 Carlton Ave, Suite 1300, WINTER HAVEN, FL 33853 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-07 |
| REINSTATEMENT | 2024-04-17 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-27 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-04-04 |
| Florida Limited Liability | 2016-07-19 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1496307303 | 2020-04-28 | 0455 | PPP | 1120 CARLTON AVE SUITE 1300, LAKE WHALES, FL, 33853 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
