| Entity Name: | MY HOME TELEMED LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Feb 2021 (4 years ago) |
| Document Number: | L21000080903 |
| FEI/EIN Number | 86-2306221 |
| Address: | 1156 PIEDMONT ROAD, VENICE, FL, 34293 |
| Mail Address: | 1156 PIEDMONT ROAD, VENICE, FL, 34293 |
| ZIP code: | 34293 |
| County: | Sarasota |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548848906 | 2021-03-29 | 2021-03-29 | 106 ANITA DR, EGG HARBOR TOWNSHIP, NJ, 082347522, US | 1156 PIEDMONT RD, VENICE, FL, 342934843, US | |||||||||||||||||||||
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| Phone | +1 609-432-5417 |
| Fax | 6097888111 |
Authorized person
| Name | DR. DENISE S TRUMBAUER |
| Role | OWNER, CEO |
| Phone | 6094325417 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 60062926 |
| State | NJ |
| Name | Role |
|---|---|
| AGENTS AND CORPORATIONS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| DENISE TRUMBAUER | Authorized Member | 1156 PIEDMONT ROAD, VENICE, FL, 34293 |
| Name | Role | Address |
|---|---|---|
| DENISE TRUMBAUER | Manager | 1156 PIEDMONT ROAD, VENICE, FL, 34293 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-11-12 | 91 NINTH STREET SOUTH, SUITE 330, NAPLES, FL 34102 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-14 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-04-01 |
| Florida Limited Liability | 2021-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
