| Entity Name: | BREVARD HEALTH GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Jul 2018 (7 years ago) |
| Document Number: | L18000171707 |
| FEI/EIN Number | 83-1265986 |
| Address: | 7332 OFFICE PARK PLACE, MELBOURNE, FL, 32940, US |
| Mail Address: | 7332 OFFICE PARK PLACE, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346723244 | 2018-09-07 | 2018-10-10 | 30 MOUNTAIN TER, ASHEVILLE, NC, 288061924, US | 1301 W EAU GALLIE BLVD STE 112, MELBOURNE, FL, 32935, US | |||||||||||||||||||
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| Phone | +1 828-450-7064 |
| Fax | 8554222581 |
| Phone | +1 321-327-9788 |
| Fax | 3213207636 |
Authorized person
| Name | VIJAY KATUKURI |
| Role | OWNER |
| Phone | 2487070920 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KATUKURI VIJAY MD | Agent | 6414 Modern Duran Dr, MELBOURNE, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| KATUKURI VIJAY MD | Manager | 7332 OFFICE PARK PLACE, MELBOURNE, FL, 32940 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000080307 | BREVARD SPINE AND REHAB INSTITUTE | ACTIVE | 2018-07-26 | 2028-12-31 | No data | 7332 OFFICE PARK PLACE, STE 103, MELBOURNE, FL, 32940 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-27 | 7332 OFFICE PARK PLACE, Suite 103, MELBOURNE, FL 32940 | No data |
| CHANGE OF MAILING ADDRESS | 2021-09-27 | 7332 OFFICE PARK PLACE, Suite 103, MELBOURNE, FL 32940 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-13 | 6414 Modern Duran Dr, MELBOURNE, FL 32940 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-09 |
| ANNUAL REPORT | 2021-01-06 |
| ANNUAL REPORT | 2020-01-13 |
| ANNUAL REPORT | 2019-02-09 |
| Florida Limited Liability | 2018-07-17 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
