| Entity Name: | PROGRESSIVE HEALTHCARE OF BREVARD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Apr 2019 (6 years ago) |
| Document Number: | L19000090345 |
| FEI/EIN Number | 83-4237283 |
| Address: | 5972 GOLETA CIR., MELBOURNE, FL, 32940, US |
| Mail Address: | 5972 GOLETA CIRCLE, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134769698 | 2020-01-13 | 2020-01-13 | 5972 GOLETA CIR, MELBOURNE, FL, 329408035, US | 5972 GOLETA CIR, MELBOURNE, FL, 329408035, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 321-615-0990 |
| Fax | 8883418272 |
Authorized person
| Name | GWEN MUNDORF |
| Role | THERAPIST |
| Phone | 3216150990 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MUNDORF KENNETH T | Agent | 5972 GOLETA CIRCLE, MELBOURNE, FL, 32937 |
| Name | Role | Address |
|---|---|---|
| MUNDORF KENNETH T | Manager | 5972 GOLETA CIRCLE, MELBOURNE, FL, 32940 |
| MUNDORF GWEN A | Manager | 5972 GOLETA CIRCLE, MELBOURNE, FL, 32940 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-03 |
| ANNUAL REPORT | 2023-02-11 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-02-05 |
| ANNUAL REPORT | 2020-05-27 |
| Florida Limited Liability | 2019-04-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
