| Entity Name: | WELL CARE INTEGRATIVE MEDICINE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Jul 2018 (7 years ago) |
| Document Number: | L18000176860 |
| FEI/EIN Number | 83-1488332 |
| Address: | 1920 PALM BEACH LAKES BLVD SUITES 212 &213, WEST PALM BEACH, FL, 33407, US |
| Mail Address: | 1920 PALM BEACH LAKES BLVD SUITES 212 &213, WEST PALM BEACH, FL, 33407, US |
| ZIP code: | 33407 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629541859 | 2019-01-10 | 2019-01-25 | 1920 PALM BEACH LAKES BLVD STE 212, WEST PALM BEACH, FL, 334093506, US | 1920 PALM BEACH LAKES BLVD STE 212, WEST PALM BEACH, FL, 334093506, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-296-8787 |
| Fax | 5612968788 |
Authorized person
| Name | DR. CARLINE CLERGE |
| Role | DIRECTOR |
| Phone | 5612968787 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | No |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF FL |
| Number | 89634 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLERGE-LEGER CARLINE | Agent | 1920 PALM BEACH LAKES BLVD SUITE #212, WEST PALM BEACH, FL, 33407 |
| Name | Role | Address |
|---|---|---|
| CLERGE-LEGER CARLINE | Manager | 1920 PALM BEACH LAKES BLVD SUITES 212 &213, WEST PALM BEACH, FL, 33407 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 1920 PALM BEACH LAKES BLVD SUITE #212, WEST PALM BEACH, FL 33407 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-05-02 |
| ANNUAL REPORT | 2022-05-05 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| Florida Limited Liability | 2018-07-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
