| Entity Name: | TREASURE COAST KETAMINE WELLNESS & IV NUTRITION CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jun 2020 (5 years ago) |
| Document Number: | L20000179035 |
| FEI/EIN Number | 85-1614860 |
| Address: | 787 37th Street, Suite E110, VERO BEACH, FL, 32960, US |
| Mail Address: | 787 37th Street, E110, VERO BEACH, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801408208 | 2020-08-18 | 2022-04-28 | 777 37TH ST STE B106, VERO BEACH, FL, 329607301, US | 777 37TH ST STE B106, VERO BEACH, FL, 329607301, US | |||||||||||||||||||
|
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| Phone | +1 772-907-5917 |
| Fax | 7729075917 |
Authorized person
| Name | GREGORY JARRELL MCCRACKEN |
| Role | OWNER |
| Phone | 3522628439 |
Taxonomy
| Taxonomy Code | 163WI0500X - Infusion Therapy Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MCCRACKEN JENNIFER L | Agent | 597 BENEDICTINE TER, SEBASTIAN, FL, 32958 |
| Name | Role | Address |
|---|---|---|
| MCCRACKEN GREGORY J | Chief Executive Officer | 597 BENEDICTINE TER, SEBASTIAN, FL, 32958 |
| Name | Role | Address |
|---|---|---|
| MCCRACKEN JENNIFER L | Chief Financial Officer | 597 BENEDICTINE TER, SEBASTIAN, FL, 32958 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-23 | 787 37th Street, Suite E110, VERO BEACH, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-23 | 787 37th Street, Suite E110, VERO BEACH, FL 32960 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-23 |
| Florida Limited Liability | 2020-06-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
