| Entity Name: | THREE OAKS FAMILY MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 31 Jul 2020 (4 years ago) |
| Document Number: | L20000229421 |
| FEI/EIN Number | 85-2417505 |
| Address: | 825 EAST COWBOY WAY, 102, LABELLE, FL 33935 |
| Mail Address: | 825 EAST COWBOY WAY, 103, LABELLE, FL 33935 |
| ZIP code: | 33935 |
| County: | Hendry |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194336701 | 2020-08-17 | 2020-08-17 | 325 VIA DEL AQUA, CLEWISTON, FL, 334402422, US | 825 E COWBOY WAY, UNITS 102/103, LABELLE, FL, 33935, US | |||||||||||||
|
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| Phone | +1 239-560-2657 |
Authorized person
| Name | AMANDA PACHECO |
| Role | OWNER/PROVIDER |
| Phone | 2395602657 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PACHECO, AMANDA M | Agent | 325 VIA DEL AQUA, N/A, CLEWISTON, FL 33440 |
| Name | Role | Address |
|---|---|---|
| PACHECO, AMANDA M | Manager | 325 VIA DEL AQUA, CLEWISTON, FL 33440 |
| LUCK, VALAREE A | Manager | 323 VIA DEL AQUA, CLEWISTON, FL 33440 |
| DOMINGUEZ-GIRON, JANET | Manager | 6040 TWIG CT, LABELLE, FL 33935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-04-22 | 825 EAST COWBOY WAY, 102, LABELLE, FL 33935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-27 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-04-22 |
| Florida Limited Liability | 2020-07-31 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
