| Entity Name: | PROGRESSIVE HEALTH CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Jan 2019 (6 years ago) |
| Document Number: | L19000004497 |
| FEI/EIN Number | 83-3098388 |
| Address: | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL, 32548, US |
| Mail Address: | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL, 32548, US |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811457716 | 2019-03-25 | 2019-04-24 | 29G MIRACLE STRIP PKWY SW, FORT WALTON BEACH, FL, 325486655, US | 29G MIRACLE STRIP PKWY SW, FORT WALTON BEACH, FL, 325486655, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 334-437-4308 |
Authorized person
| Name | ANDREW A GODWIN |
| Role | OWNER/PROVIDER |
| Phone | 8503743926 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GODWIN ANDREW A | Agent | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL, 32548 |
| Name | Role | Address |
|---|---|---|
| GODWIN ANDREW A | Manager | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2021-04-02 | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL 32548 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-24 | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL 32548 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-24 | 29G MIRACLE STRIP PARKWAY SW, FORT WALTON BEACH, FL 32548 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-02-11 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-03-26 |
| Florida Limited Liability | 2019-01-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
