| Entity Name: | NAMASTE NOURISHED, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Jan 2018 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 03 May 2022 (3 years ago) |
| Document Number: | L18000014864 |
| FEI/EIN Number | 82-4081498 |
| Address: | 2425 E. Commercial Blvd, Fort Lauderdale, FL, 33308, US |
| Mail Address: | 4451 NE 13th Terrace, Oakland Park, FL, 33334, US |
| ZIP code: | 33308 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861145260 | 2022-01-27 | 2022-01-27 | 2425 E COMMERCIAL BLVD STE 202, FORT LAUDERDALE, FL, 333084062, US | 2425 E COMMERCIAL BLVD STE 202, FORT LAUDERDALE, FL, 333084062, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-641-2210 |
Authorized person
| Name | KERRY MCCARTHY |
| Role | FOUNDER |
| Phone | 6315122157 |
Taxonomy
| Taxonomy Code | 133V00000X - Registered Dietitian |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1043794399 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1154726875 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| McCarthy KERRY | Agent | 2425 EAST COMMERCIAL BOULEVARD, FORT LAUDERDALE, FL, 33308 |
| Name | Role | Address |
|---|---|---|
| MCCARTHY KERRY | Manager | 4451 NE 13TH TERRACE, OAKLAND PARK, FL, 33334 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-10 | 1915 NE 45th Street, Suite 210, Fort Lauderdale, FL 33308 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-10 | 1915 NE 45th Street, SUITE 210, Fort Lauderdale, FL 33308 | No data |
| LC AMENDMENT | 2022-05-03 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-11 | 1915 NE 45th Street, Suite 210, Fort Lauderdale, FL 33308 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-14 | McCarthy, KERRY | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-10 |
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-25 |
| LC Amendment | 2022-05-03 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-02-11 |
| Florida Limited Liability | 2018-01-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
