| Entity Name: | JACKSON REEF LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Jul 2017 (8 years ago) |
| Document Number: | L17000163092 |
| FEI/EIN Number | 82-2340762 |
| Address: | 1360 N US Hwy 1 #107, Ormond Beach, FL, 32174, US |
| Mail Address: | 1360 N US Hwy 1 #107, Ormond Beach, FL, 32174, US |
| ZIP code: | 32174 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396398608 | 2019-07-17 | 2020-08-07 | 495 S NOVA RD STE 101A, ORMOND BEACH, FL, 321748444, US | 495 S NOVA RD STE 101A, ORMOND BEACH, FL, 321748444, US | |||||||||||||||
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| Phone | +1 386-487-4673 |
| Fax | 8558295770 |
Authorized person
| Name | DR. WILLIAM LOUIS SELF |
| Role | OWNER |
| Phone | 3864874673 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SELF WILLIAM L | Agent | 30 CHOCTAW TRAIL, ORMOND BEACH, FL, 32174 |
| Name | Role | Address |
|---|---|---|
| MONTALVO CARLOS N | Authorized Member | 42 EMERALD OAKS LANE, ORMOND BEACH, FL, 32174 |
| SELF WILLIAM L | Authorized Member | 30 CHOCTAW TRAIL, ORMOND BEACH, FL, 32174 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000082877 | AFFIRMED HEALTH CENTERS | ACTIVE | 2021-06-22 | 2026-12-31 | No data | 495 S. NOVA RD, #101A, ORMOND BEACH, FL, 32174 |
| G19000063828 | LIFE IS KETAFUL | EXPIRED | 2019-06-02 | 2024-12-31 | No data | 851 DUNLAWTON AVE, SUITE 104, PORT ORANGE, FL, 32127 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-06-13 | 1360 N US Hwy 1 #107, Ormond Beach, FL 32174 | No data |
| CHANGE OF MAILING ADDRESS | 2023-06-13 | 1360 N US Hwy 1 #107, Ormond Beach, FL 32174 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-16 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-05-25 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-03-28 |
| Florida Limited Liability | 2017-07-31 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
