| Entity Name: | K-VILLE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
K-VILLE LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 25 Jan 2021 (4 years ago) |
| Document Number: | L21000045811 |
| FEI/EIN Number |
86-2012495
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 2102 S Ridgewood Ave, Edgewater, FL, 32141, US |
| Mail Address: | 2102 S Ridgewood Ave, Edgewater, FL, 32141, US |
| ZIP code: | 32141 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1932862513 | 2021-10-20 | 2023-05-12 | 2102 S RIDGEWOOD AVE STE 17, EDGEWATER, FL, 321414230, US | 2102 S RIDGEWOOD AVE STE 17, EDGEWATER, FL, 321414230, US | |||||||||||||||||||||||||||
|
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| Phone | +1 386-402-8346 |
Authorized person
| Name | KATY REDEL |
| Role | CLINICIAN/ OWNER |
| Phone | 3864028346 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 101YP2500X - Professional Counselor |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021586900 |
| State | FL |
| Issuer | CAQH |
| Number | 13995716 |
| Name | Role | Address |
|---|---|---|
| REDEL KATY A | Authorized Member | 411 ARMOYAN WAY, NEW SMYRNA BEACH, FL, 32168 |
| UNITED STATES CORPORATION AGENTS, INC. | Agent | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000078422 | MINDFUL HEALING | ACTIVE | 2021-06-11 | 2026-12-31 | - | 2102 S RIDGEWOOD AVENUE, UNIT #17, EDGEWATER, FL, 32141 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2025-01-07 | 2102 S Ridgewood Ave, Ste 17, Edgewater, FL 32141 | - |
| CHANGE OF MAILING ADDRESS | 2025-01-07 | 2102 S Ridgewood Ave, Ste 17, Edgewater, FL 32141 | - |
| REGISTERED AGENT NAME CHANGED | 2025-01-07 | UNITED STATES CORPORATION AGENTS, INC. | - |
| CHANGE OF MAILING ADDRESS | 2024-11-24 | 411 Armoyan Way, New Smyrna Beach, FL 32168 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-20 | 411 Armoyan Way, New Smyrna Beach, FL 32168 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-03 | 476 RIVERSIDE AVE., JACKSONVILLE, FL 32202 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| AMENDED ANNUAL REPORT | 2024-11-24 |
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-05-12 |
| Florida Limited Liability | 2021-01-25 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
