| Entity Name: | BACK 2 BASICS OT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 19 Mar 2018 (7 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L18000071096 |
| FEI/EIN Number | 82-4977605 |
| Address: | 134 HONORS WAY, WINTER SPRINGS, FL 32708 |
| Mail Address: | 134 HONORS WAY, WINTER SPRINGS, FL 32708 |
| ZIP code: | 32708 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780170498 | 2018-07-05 | 2018-09-25 | 134 HONORS WAY, WINTER SPRINGS, FL, 327086352, US | 134 HONORS WAY, WINTER SPRINGS, FL, 327086352, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 407-376-2592 |
| Fax | 4073694221 |
Authorized person
| Name | SOLINA BRAININ-MATTOS |
| Role | OWNER/PRESIDENT |
| Phone | 4073762592 |
Taxonomy
| Taxonomy Code | 225XP0200X - Pediatric Occupational Therapist |
| License Number | OT14072 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1043503485 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRAININ-MATTOS, SOLINA | Agent | 134 HONORS WAY, WINTER SPRINGS, FL 32708 |
| Name | Role | Address |
|---|---|---|
| BRAININ-MATTOS, SOLINA | Manager | 134 HONORS WAY, WINTER SPRINGS, FL 32708 |
| Name | Role | Address |
|---|---|---|
| PAGAN-RIVERA, ENRIQUE A | Authorized Representative | 134 HONORS WAY, WINTER SPRINGS, FL 32708 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-29 |
| Florida Limited Liability | 2018-03-19 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
