| Entity Name: | BEAUTIFUL MIND CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 01 Oct 2018 (6 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L18000232273 |
| FEI/EIN Number | 83-2101032 |
| Mail Address: | 8815 Conroy Windermere Rd, Orlando, FL, 32835, US |
| Address: | 7208 W Sand Lake Road, ORLANDO, FL, 32819, US |
| ZIP code: | 32819 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184190753 | 2018-10-22 | 2020-12-23 | 7208 W SAND LAKE RD STE 305, ORLANDO, FL, 328195279, US | 7208 W SAND LAKE RD STE 305, ORLANDO, FL, 328195279, US | |||||||||||||||||||||
|
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| Phone | +1 407-799-8808 |
| Fax | 4074404307 |
Authorized person
| Name | MR. DAMON LAI |
| Role | HEALTHCARE ADMINISTRATOR |
| Phone | 4077998808 |
Taxonomy
| Taxonomy Code | 2084N0400X - Neurology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAL LICENSE |
| Number | ME114891 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Huynh Phuong K | Agent | 8815 Conroy Windermere Rd, Orlando, FL, 32835 |
| Name | Role | Address |
|---|---|---|
| Lai Kenneth E | Manager | 7208 W Sand Lake Road, ORLANDO, FL, 32819 |
| Huynh Phuong K | Manager | 7208 W Sand Lake Road, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| LC REVOCATION OF DISSOLUTION | 2023-07-28 | No data | No data |
| VOLUNTARY DISSOLUTION | 2023-07-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-02-25 | Huynh, Phuong Kim | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-02-21 | 7208 W Sand Lake Road, Suite 305, ORLANDO, FL 32819 | No data |
| CHANGE OF MAILING ADDRESS | 2020-02-21 | 7208 W Sand Lake Road, Suite 305, ORLANDO, FL 32819 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-02-21 | 8815 Conroy Windermere Rd, 628, Orlando, FL 32835 | No data |
| Name | Date |
|---|---|
| LC Revocation of Dissolution | 2023-07-28 |
| VOLUNTARY DISSOLUTION | 2023-07-05 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-02-19 |
| AMENDED ANNUAL REPORT | 2020-02-27 |
| AMENDED ANNUAL REPORT | 2020-02-25 |
| ANNUAL REPORT | 2020-02-21 |
| ANNUAL REPORT | 2019-01-19 |
| Florida Limited Liability | 2018-10-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
