| Entity Name: | A MOTHER'S VILLAGE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Jan 2020 (5 years ago) |
| Document Number: | L20000023473 |
| FEI/EIN Number | 84-4519507 |
| Address: | 5455 SE Maricamp Rd, Ocala, FL, 34480, US |
| Mail Address: | 12285 SE 70 AVE RD, BELLEVIEW, FL, 34420 |
| ZIP code: | 34480 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275251654 | 2022-08-22 | 2023-05-25 | 12285 SE 70TH AVENUE RD, BELLEVIEW, FL, 344204673, US | 5455 SE MARICAMP RD, OCALA, FL, 344807417, US | |||||||||||||||||||||||||
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| Phone | +1 352-470-7565 |
| Fax | 3529001978 |
Authorized person
| Name | MRS. REBECCA MERRELL CARLSON |
| Role | OWNER |
| Phone | 3524707565 |
Taxonomy
| Taxonomy Code | 261QB0400X - Birthing Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM2500X - Medical Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | MW408 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARLSON Rebecca M | Agent | 5455 SE Maricamp Rd, Ocala, FL, 34480 |
| Name | Role | Address |
|---|---|---|
| CARLSON Rebecca M | President | 5455 SE Maricamp Rd, Ocala, FL, 34480 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000041128 | A MOTHER'S VILLAGE BIRTH CENTER OF OCALA | ACTIVE | 2023-03-30 | 2028-12-31 | No data | 5455 SE MARICAMP RD, OCALA, FL, 34480 |
| G22000098539 | A MOTHER'S VILLAGE COMMUNITY BIRTH CENTER | ACTIVE | 2022-08-20 | 2027-12-31 | No data | 12285 SE 70 AVE RD, BELLEVIEW, FL, 34420 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-03 | 5455 SE Maricamp Rd, Ocala, FL 34480 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-03 | 5455 SE Maricamp Rd, Ocala, FL 34480 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-20 | CARLSON, Rebecca Merrell | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-06 |
| ANNUAL REPORT | 2023-03-03 |
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-13 |
| Florida Limited Liability | 2020-01-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
