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MULBERRYS MOBILE PROVIDER SERVICES, LLC - Florida Company Profile

Company Details

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.
In Florida, LLCs are governed by Title XXXVI, Chapter 605, Florida Revised Limited Liability Company Act

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

National Provider Identifier

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

Contacts

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

Key Officers & Management

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

Events

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 -

Documents

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