| Entity Name: | HYDRATION EXPERIENCE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Dec 2020 (4 years ago) |
| Document Number: | L20000393942 |
| FEI/EIN Number | 86-1368275 |
| Address: | 1329 NW 10th Street, Dania Beach, FL, 33004, US |
| Mail Address: | 1329 NW 10TH STREET, DANIA BEACH, FL, 33004 |
| ZIP code: | 33004 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679167894 | 2021-02-28 | 2021-02-28 | 1329 NW 10TH ST, DANIA BEACH, FL, 330042341, US | 1329 NW 10TH ST, DANIA BEACH, FL, 330042341, US | |||||||||||||||||||
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| Phone | +1 954-765-9521 |
Authorized person
| Name | LOCIANNA BLACKWELL |
| Role | NURSE PRACTITIONER |
| Phone | 9547659521 |
Taxonomy
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1356657704 |
| State | GA |
| Name | Role | Address |
|---|---|---|
| BLACKWELL LOCIANNA C | Agent | 1329 NW 10TH STREET, DANIA BEACH, FL, 33004 |
| Name | Role | Address |
|---|---|---|
| BLACKWELL LOCIANNA C | Auth | 1329 NW 10TH STREET, DANIA BEACH, FL, 33004 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-26 | 1329 NW 10th Street, Dania Beach, FL 33004 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-08 |
| ANNUAL REPORT | 2023-03-26 |
| ANNUAL REPORT | 2022-03-22 |
| AMENDED ANNUAL REPORT | 2021-03-21 |
| ANNUAL REPORT | 2021-03-04 |
| Florida Limited Liability | 2020-12-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
