| Entity Name: | SPARTAN HEALTH ALLIANCE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 30 Dec 2019 (5 years ago) |
| Document Number: | L20000007490 |
| FEI/EIN Number | 84-4413521 |
| Address: | 3040 N. Wickham Rd, Suite 3, MELBOURNE, FL 32955 |
| Mail Address: | 3040 N. Wickham Rd, Suite 3, MELBOURNE, FL 32955 |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497409767 | 2022-02-07 | 2023-08-21 | 3040 N WICKHAM RD STE 3, MELBOURNE, FL, 329352369, US | 3040 N WICKHAM RD STE 3, MELBOURNE, FL, 329352369, US | |||||||||||||||
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| Phone | +1 321-456-9653 |
| Fax | 3212049168 |
Authorized person
| Name | MR. HARRY W CARROLL IV |
| Role | MGR |
| Phone | 9542054551 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CARROLL, HARRY | Agent | 3040 N. Wickham Rd, Suite 3, Suite 3, Melbourne, FL 32935 |
| Name | Role | Address |
|---|---|---|
| Carroll, Harry W | Manager | 3040 N. Wickham Rd, Suite 3, Suite 3 Melbourne, FL 32935 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000005347 | SUNTREE PSYCHIATRY | ACTIVE | 2022-01-14 | 2027-12-31 | No data | 7145 TURNER RD., SUITE 102, ROCKLEDGE, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-05 | 3040 N. Wickham Rd, Suite 3, Suite 3, Melbourne, FL 32935 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-11 | 3040 N. Wickham Rd, Suite 3, MELBOURNE, FL 32955 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-11 | 3040 N. Wickham Rd, Suite 3, MELBOURNE, FL 32955 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-15 |
| ANNUAL REPORT | 2024-02-23 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-04-28 |
| Florida Limited Liability | 2019-12-30 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
