| Entity Name: | GRACE FAMILY MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Feb 2017 (8 years ago) |
| Document Number: | L17000035509 |
| FEI/EIN Number | 37-1850390 |
| Address: | 12788 W. Forest Hill Blvd., 1004, Wellington, FL 33414 |
| Mail Address: | 11191 Grandview Manor, Wellington, FL 33414 |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831712801 | 2020-05-25 | 2024-06-27 | 11191 GRANDVIEW MNR, WELLINGTON, FL, 334148840, US | 12788 FOREST HILL BLVD STE 1004, WELLINGTON, FL, 334144703, US | |||||||||||||||||||||
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| Phone | +1 561-317-2389 |
| Phone | +1 561-331-5155 |
| Fax | 5619076019 |
Authorized person
| Name | CARLOS POVEDA |
| Role | MANAGER |
| Phone | 5613172389 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| POVEDA PRACTICE CONSULTING, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| POVEDA PRACTICE CONSULTING, LLC | Authorized Member | No data |
| POVEDA, LEON, M.D. | Authorized Member | 5425 Sunseeker Blvd, Greenacres, FL 33463 |
| Poveda, Jessica | Authorized Member | 11191 Grandview Manor, Wellington, FL 33414 |
| Name | Role | Address |
|---|---|---|
| POVEDA, LEON, M.D. | Director | 5425 Sunseeker Blvd, Greenacres, FL 33463 |
| Poveda, Jessica | Director | 11191 Grandview Manor, Wellington, FL 33414 |
| Name | Role |
|---|---|
| POVEDA PRACTICE CONSULTING, LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-03 | 12788 W. Forest Hill Blvd., 1004, Wellington, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-17 | 12788 W. Forest Hill Blvd., 1004, Wellington, FL 33414 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-17 | 11191 Grandview Manor, Wellington, FL 33414 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-20 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-01-03 |
| ANNUAL REPORT | 2021-04-24 |
| ANNUAL REPORT | 2020-05-22 |
| ANNUAL REPORT | 2019-01-08 |
| ANNUAL REPORT | 2018-04-17 |
| Florida Limited Liability | 2017-02-14 |
Date of last update: 18 Feb 2025
Sources: Florida Department of State
