| Entity Name: | PINE GROVE COUNSELING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Oct 2020 (4 years ago) |
| Document Number: | L20000328394 |
| FEI/EIN Number | 85-3637825 |
| Address: | 1516 Village Center Drive, 303, Lakelane, FL, 33803, US |
| Mail Address: | 1516 Village Center Drive, 303, Lakelane, FL, 33803, US |
| ZIP code: | 33803 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255931101 | 2020-10-29 | 2020-10-29 | 539 SE VAN LOON TER, CAPE CORAL, FL, 339901157, US | 539 SE VAN LOON TER, CAPE CORAL, FL, 339901157, US | |||||||||||||||||||||
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| Phone | +1 941-763-0724 |
| Fax | 2395679671 |
Authorized person
| Name | CHRISTOPHER ERIC GROVE |
| Role | OWNER |
| Phone | 9417630724 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1992144810 |
| State | FL |
| Name | Role |
|---|---|
| ZENBUSINESS INC. | Agent |
| Name | Role | Address |
|---|---|---|
| GROVE CHRISTOPHER E | Authorized Member | 1516 Village Center Drive, Lakelane, FL, 33803 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-15 | 1516 Village Center Drive, 303, Lakelane, FL 33803 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-15 | 1516 Village Center Drive, 303, Lakelane, FL 33803 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-06-29 | ZenBusiness Inc. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-06-29 | 336 E. College Ave., STE 301, Tallahassee, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-06-29 |
| ANNUAL REPORT | 2021-04-07 |
| Florida Limited Liability | 2020-10-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
