| Entity Name: | COMPLETE MEDICAL CARE HEALTH & WELLNESS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Dec 2019 (5 years ago) |
| Document Number: | L19000301926 |
| FEI/EIN Number | 844015868 |
| Address: | 7151 UNIVERSITY BLVD., STE. 120, WINTER PARK, FL, 32792, US |
| Mail Address: | 7151 UNIVERSITY BLVD., STE. 120, WINTER PARK, FL, 32792, US |
| ZIP code: | 32792 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538936661 | 2023-12-08 | 2023-12-08 | 7151 UNIVERSITY BLVD STE 120, WINTER PARK, FL, 327926724, US | 7151 UNIVERSITY BLVD STE 120, WINTER PARK, FL, 327926724, US | |||||||||||||||||||||||||||
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| Phone | +1 407-418-5556 |
| Fax | 4074185559 |
Authorized person
| Name | MARK SCHELLHAMMER |
| Role | MEDICAL DIRECTOR |
| Phone | 4074185556 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1568567766 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1154689798 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ACOSTA LEIDY P | Agent | 7151 UNIVERSITY BLVD., WINTER PARK, FL, 32792 |
| Name | Role | Address |
|---|---|---|
| ACOSTA LEIDY P | Manager | 7151 UNIVERSITY BLVD. STE 120, WINTER PARK, FL, 32792 |
| MCCORMICK ALEXANDRIA | Manager | 7151 UNIVERSITY BLVD. STE 120, WINTER PARK, FL, 32792 |
| Name | Role | Address |
|---|---|---|
| Schellhammer Mark | Medi | 7151 UNIVERSITY BLVD. STE 120, WINTER PARK, FL, 32792 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000106668 | CMC HEALTH & WELLNESS | ACTIVE | 2021-08-17 | 2026-12-31 | No data | 7151 UNIVERSITY BLVD SUITE 120, WINTER PARK, FL, 32792 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-01 |
| ANNUAL REPORT | 2023-03-11 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-02-04 |
| Florida Limited Liability | 2019-12-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
