| Entity Name: | MULBERRYS MOBILE PROVIDER SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
MULBERRYS MOBILE PROVIDER SERVICES, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 19 Jun 2018 (7 years ago) |
| Document Number: | L18000150105 |
| FEI/EIN Number |
83-0913765
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 6435 SE US Highway 301, Hawthorne, FL, 32640, US |
| Mail Address: | 6435 SE US Highway 301, Hawthorne, FL, 32640, US |
| ZIP code: | 32640 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831683861 | 2018-06-22 | 2021-02-08 | 6435 SE US HIGHWAY 301, HAWTHORNE, FL, 326407309, US | 6435 SE US HIGHWAY 301, HAWTHORNE, FL, 326407309, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 352-358-8070 |
| Fax | 9495774783 |
Authorized person
| Name | DR. MICHELL MULBERRY |
| Role | PROVIDER, OWNER |
| Phone | 3523588070 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106245700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 107001000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MULBERRY MICHELL | Owne | 640 Lake Susan Road, Hawthorne, FL, 32640 |
| Jalloh Usman T | Manager | 640 Lake Susan Road, Hawthorne, FL, 32640 |
| Mulberry Vincent K | Manager | 640 Lake Susan Road, Hawthorne, FL, 32640 |
| Mulberry Michell | Agent | 640 LAKE SUSAN ROAD, HAWTHORNE, FL, 32640 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-03 | Mulberry, Michell | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-26 | 640 LAKE SUSAN ROAD, HAWTHORNE, FL 32640 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2021-02-02 | 6435 SE US Highway 301, Hawthorne, FL 32640 | - |
| CHANGE OF MAILING ADDRESS | 2021-02-02 | 6435 SE US Highway 301, Hawthorne, FL 32640 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-01-26 |
| AMENDED ANNUAL REPORT | 2021-06-23 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-02-13 |
| ANNUAL REPORT | 2019-04-29 |
| Florida Limited Liability | 2018-06-19 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
