| Entity Name: | ERTEL ABA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Dec 2020 (4 years ago) |
| Document Number: | L21000001487 |
| FEI/EIN Number | 86-1229423 |
| Address: | 6824 Vintage Ave, Port Orange, FL, 32128, UN |
| Mail Address: | 6824 Vintage Ave, Port Orange, FL, 32128, UN |
| ZIP code: | 32128 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881369643 | 2021-08-13 | 2022-01-06 | 6824 VINTAGE LN, PORT ORANGE, FL, 321284093, US | 6824 VINTAGE LN, PORT ORANGE, FL, 321284093, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 757-375-3461 |
Authorized person
| Name | DR. HALLIE ERTEL |
| Role | OWNER |
| Phone | 7573753461 |
Taxonomy
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ERTEL HALLIE MDR | Agent | 6824 Vintage Ave, Port Orange, FL, 32128 |
| Name | Role | Address |
|---|---|---|
| ERTEL HALLIE MDR | Authorized Representative | 6824 Vintage Ave, Port Orange, 32128 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000108523 | ATLANTIC COAST ABA | ACTIVE | 2021-08-21 | 2026-12-31 | No data | 431 LUNA BELLA LANE APT 322, NEW SMYRNA, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-08 | 6824 Vintage Ave, Port Orange, FL 32128 UN | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-08 | 6824 Vintage Ave, Port Orange, FL 32128 UN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-08 | 6824 Vintage Ave, Port Orange, FL 32128 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-03-08 |
| Florida Limited Liability | 2020-12-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
