| Entity Name: | ST. LUCIE INJURY AND HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Nov 2017 (7 years ago) |
| Document Number: | L17000227365 |
| FEI/EIN Number | 82-3336983 |
| Address: | 2705 Peters Rd, FORT PIERCE, FL, 34945, US |
| Mail Address: | 2705 Peters Rd, FORT PIERCE, FL, 34945, US |
| ZIP code: | 34945 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770096653 | 2017-11-14 | 2021-01-04 | 4842 N KINGS HWY, FORT PIERCE, FL, 349512243, US | 4842 N KINGS HWY, FORT PIERCE, FL, 349512243, US | |||||||||||||||||||||||||||||
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| Phone | +1 772-882-0701 |
| Fax | 8889201114 |
Authorized person
| Name | DR. SUSAN PARKER SANDERS |
| Role | CEO |
| Phone | 7728820701 |
Taxonomy
| Taxonomy Code | 111NR0400X - Rehabilitation Chiropractor |
| Is Primary | Yes |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 019857200 |
| State | FL |
| Issuer | DOT ME# |
| Number | 8754334744 |
| Name | Role | Address |
|---|---|---|
| SANDERS SUSAN P | Agent | 1810 Newport Isles Boulevard, Port St. Lucie, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| Sanders Susan P | Manager | 1810 Newport Isles Boulevard, Fort Pierce, FL, 34945 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000049789 | OCCMEDFL | ACTIVE | 2023-04-19 | 2028-12-31 | No data | 4842 N KINGS HWY, FORT PIERCE, FL, 34951 |
| G18000046552 | ST. LUCIE CHIROPRACTIC | ACTIVE | 2018-04-11 | 2028-12-31 | No data | 4842 N KINGS HWY, FORT PIERCE, FL, 34951 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-10 | 1810 Newport Isles Boulevard, Port St. Lucie, FL 34953 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-11-01 | 2705 Peters Rd, Suite 50-9, FORT PIERCE, FL 34945 | No data |
| CHANGE OF MAILING ADDRESS | 2023-11-01 | 2705 Peters Rd, Suite 50-9, FORT PIERCE, FL 34945 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-08 |
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-01-18 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-01-09 |
| ANNUAL REPORT | 2018-08-24 |
| Florida Limited Liability | 2017-11-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
