| Entity Name: | GENESIS GROUP OF FAMILY PRACTICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 May 2017 (8 years ago) |
| Document Number: | L17000102998 |
| FEI/EIN Number | 46-1045369 |
| Mail Address: | 1133 SAXON BLVD, 200, ORANGE CITY, FL 32763 |
| Address: | 800 S NOVA RD, J, ORMOND BEACH, FL 32763 |
| ZIP code: | 32763 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215464094 | 2017-05-11 | 2017-05-11 | 1133 SAXON BLVD, STE 100, ORANGE CITY, FL, 327638425, US | 800 S NOVA RD, STE J, ORMOND BEACH, FL, 321749048, US | |||||||||||||||||
|
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| Phone | +1 386-218-2353 |
Authorized person
| Name | JAY C CHANMUGAM |
| Role | PRESIDENT |
| Phone | 3862182353 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | OS8600 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CHANMUGAM, JAY C | Agent | 1133 SAXON BLVD, 200, ORANGE CITY, FL 32763 |
| Name | Role | Address |
|---|---|---|
| CHANMUGAM, JAY | Manager | 1133 SAXON BLVD STE 200, ORANGE CITY, FL, FL 32763 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2018-04-23 | 800 S NOVA RD, J, ORMOND BEACH, FL 32763 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-23 |
| Florida Limited Liability | 2017-05-09 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
