| Entity Name: | COGNITIVE HEALTH & WELLNESS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 13 Aug 2020 (4 years ago) |
| Document Number: | L20000238474 |
| FEI/EIN Number | 85-3733997 |
| Address: | 838 W. Desoto St., Unit 8H, Clermont, FL 34711 |
| Mail Address: | 838 W. Desoto St., Unit 8H, Clermont, FL 34711 |
| ZIP code: | 34711 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194325969 | 2020-10-29 | 2023-11-01 | 838 W DESOTO ST UNIT 8H, CLERMONT, FL, 347112110, US | 838 W DESOTO ST UNIT 8H, CLERMONT, FL, 347112110, US | |||||||||||||||||||||||||
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| Phone | +1 352-505-1788 |
| Fax | 3215947656 |
Authorized person
| Name | SHARON ANNA WALKER |
| Role | REGISTERED AGENT |
| Phone | 3522237779 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006600700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALKER, SHARON A | Agent | 1111 ARBOR HILL CIR, MINNEOLA, FL 34715 |
| Name | Role | Address |
|---|---|---|
| WALKER, SHARON A | Manager | 1111 ARBOR HILL CIR, MINNEOLA, FL 34715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-12 | 838 W. Desoto St., Unit 8H, Clermont, FL 34711 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-12 | 838 W. Desoto St., Unit 8H, Clermont, FL 34711 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-02-15 |
| Florida Limited Liability | 2020-08-13 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
