| Entity Name: | RESTORING WELLNESS PRIMARY CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 28 Jun 2017 (8 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 04 Oct 2017 (7 years ago) |
| Document Number: | L17000140450 |
| FEI/EIN Number | 82-2019439 |
| Address: | 10597 US HIGHWAY 19 N, PINELLAS PARK, FL, 33782, US |
| Mail Address: | 10597 US Highway 19 N, Pinellas Park, FL, 33782, US |
| ZIP code: | 33782 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467977827 | 2017-08-07 | 2020-10-11 | 5044 DOVER ST NE, ST PETERSBURG, FL, 337033215, US | 10597 US HIGHWAY 19 N, PINELLAS PARK, FL, 337823413, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-362-5748 |
| Fax | 7373511701 |
| Phone | +1 727-351-1700 |
| Fax | 7273511701 |
Authorized person
| Name | DR. JAIMIE LOUSIE MICKEY |
| Role | OWNER PHYSICIAN |
| Phone | 8133625748 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ME103083 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000994100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MICKEY JAIMIE LMD | Agent | 10597 US Highway 19 N, Pinellas Park, FL, 33782 |
| Name | Role | Address |
|---|---|---|
| MICKEY JAIMIE LMD | Manager | 10597 US Highway 19 N, Pinellas Park, FL, 33782 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-02-02 | 10597 US HIGHWAY 19 N, PINELLAS PARK, FL 33782 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-02-02 | 10597 US Highway 19 N, Pinellas Park, FL 33782 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-10-19 | 10597 US HIGHWAY 19 N, PINELLAS PARK, FL 33782 | No data |
| LC STMNT OF RA/RO CHG | 2017-10-04 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-08 |
| ANNUAL REPORT | 2022-04-18 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-03-04 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-04-23 |
| CORLCRACHG | 2017-10-04 |
| Florida Limited Liability | 2017-06-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
