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 | |||||||||||||||||||||||||||||||||||
|
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