| Entity Name: | TREASURE COAST NEUROSCIENCE AND WELLNESS CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Jun 2017 (8 years ago) |
| Document Number: | L17000127156 |
| FEI/EIN Number | 82-1867029 |
| Address: | 1701 S 23RD ST, FORT PIERCE, FL, 34950, US |
| Mail Address: | 8540 S 83RD CT, HICKORY HILLS, IL, 60457, US |
| ZIP code: | 34950 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093242844 | 2017-05-11 | 2022-07-21 | 1701 S 23RD ST, FORT PIERCE, FL, 349504804, US | 1701 S 23RD ST, FORT PIERCE, FL, 349504804, US | |||||||||||||||||||||||
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| Phone | +1 772-448-8600 |
Authorized person
| Name | TARIQ GHEITH |
| Role | OWNER |
| Phone | 7088562338 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| License Number | ME131849 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022360500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GHEITH TARIQ | Agent | 1701 S 23RD ST, FORT PIERCE, FL, 34950 |
| Name | Role | Address |
|---|---|---|
| GHEITH TARIQ | Authorized Representative | 8540 S 83RD CT, HICKORY HILLS, IL, 60457 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-10 |
| Florida Limited Liability | 2017-06-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
