| Entity Name: | JUPITER WELLNESS CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Aug 2018 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 11 May 2022 (3 years ago) |
| Document Number: | L18000196766 |
| FEI/EIN Number | 83-1598645 |
| Address: | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458, US |
| Mail Address: | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458, US |
| ZIP code: | 33458 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336615632 | 2018-10-15 | 2021-06-10 | 312 S OLD DIXIE HWY STE 107, JUPITER, FL, 334587489, US | 312 S OLD DIXIE HWY STE 107, JUPITER, FL, 334587489, US | |||||||||||||||||||||
|
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| Phone | +1 561-935-9622 |
| Fax | 5619359627 |
Authorized person
| Name | LORI BEDOYA |
| Role | CEO |
| Phone | 5619359622 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bedoya Lori J | Agent | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| VIDAL JUAN MD | Authorized Member | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| Bedoya Lori | Manager | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| DUCHARME DEBORAH A | Vice President | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-05-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-08-25 | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL 33458 | No data |
| CHANGE OF MAILING ADDRESS | 2020-08-25 | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL 33458 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-08-25 | 312 South Old Dixie Hwy, Unit 107, Jupiter, FL 33458 | No data |
| LC AMENDMENT | 2019-11-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-11-22 | Bedoya, Lori J | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-09-20 |
| REINSTATEMENT | 2022-05-11 |
| ANNUAL REPORT | 2020-08-25 |
| AMENDED ANNUAL REPORT | 2019-12-01 |
| LC Amendment | 2019-11-22 |
| AMENDED ANNUAL REPORT | 2019-11-19 |
| AMENDED ANNUAL REPORT | 2019-07-29 |
| ANNUAL REPORT | 2019-06-04 |
| Florida Limited Liability | 2018-08-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
