| Entity Name: | WELL SPACE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Aug 2018 (6 years ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 14 May 2020 (5 years ago) |
| Document Number: | L18000201058 |
| FEI/EIN Number | 83-1669836 |
| Address: | 941 Tamiami Trail, Port Charlotte, FL, 33953, US |
| Mail Address: | 3606 14TH STREET SW, LEHIGH ACRES, FL, 33976, US |
| ZIP code: | 33953 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366030934 | 2021-01-08 | 2021-01-08 | 3606 14TH ST SW, LEHIGH ACRES, FL, 339762949, US | 4206 DEL PRADO BLVD S, CAPE CORAL, FL, 339047154, US | |||||||||||||||||||
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| Phone | +1 239-677-6664 |
Authorized person
| Name | MS. KATIA JASMIN ROBINSON LUCERO |
| Role | LICENSED CLINICAL SOCIAL WORKER |
| Phone | 2396776664 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018998800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROBINSON LUCERO KATIA | Agent | 3606 14th Street SW, Lehigh Acres, FL, 33976 |
| Name | Role | Address |
|---|---|---|
| ROBINSON LUCERO KATIA | Manager | 3606 14TH STREET SW, LEHIGH ACRES, FL, 33976 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-20 | 941 Tamiami Trail, Port Charlotte, FL 33953 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-16 | 3606 14th Street SW, Lehigh Acres, FL 33976 | No data |
| LC NAME CHANGE | 2020-05-14 | WELL SPACE, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-17 |
| ANNUAL REPORT | 2023-02-06 |
| ANNUAL REPORT | 2022-02-20 |
| ANNUAL REPORT | 2021-03-16 |
| AMENDED ANNUAL REPORT | 2020-06-25 |
| LC Name Change | 2020-05-14 |
| ANNUAL REPORT | 2020-03-17 |
| ANNUAL REPORT | 2019-02-08 |
| Florida Limited Liability | 2018-08-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
