| Entity Name: | REJUVENATION CARE CLINIC OF CENTRAL FLORIDA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Mar 2019 (6 years ago) |
| Document Number: | L19000063350 |
| FEI/EIN Number | 83-3948513 |
| Address: | 2541 S Volusia Ave Suite 100, Orlando, FL, 32763, US |
| Mail Address: | 2541 S Volusia Ave Suite 100, Orlando, FL, 32763, US |
| ZIP code: | 32763 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376005009 | 2019-04-02 | 2019-04-02 | 12221 E COLONIAL DR APT 1105, ORLANDO, FL, 328264762, US | 12221 E COLONIAL DR APT 1105, ORLANDO, FL, 328264762, US | |||||||||||||||||||
|
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| Phone | +1 800-641-9128 |
Authorized person
| Name | MR. CLAXTON COPELAND III |
| Role | PRESIDENT |
| Phone | 8006419128 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE LICENSE NUMBER |
| Number | L19000063350 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RICHARDSON ROY D | Agent | 2541 S Volusia Ave Suite 100, Orlando, FL, 32763 |
| Name | Role | Address |
|---|---|---|
| RICHARDSON ROY D | President | 2541 S Volusia Ave Suite 100, Orlando, FL, 32763 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-05-01 | 2541 S Volusia Ave Suite 100, Orlando, FL 32763 | No data |
| CHANGE OF MAILING ADDRESS | 2023-05-01 | 2541 S Volusia Ave Suite 100, Orlando, FL 32763 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-05-01 | 2541 S Volusia Ave Suite 100, Orlando, FL 32763 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-20 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-07-15 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-02-24 |
| Florida Limited Liability | 2019-03-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
