| Entity Name: | REVITALIZING LIFESTYLE MEDICINE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 25 Feb 2021 (4 years ago) |
| Document Number: | L21000093710 |
| FEI/EIN Number | 86-3170574 |
| Address: | 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 |
| Mail Address: | 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598542763 | 2023-09-12 | 2023-11-13 | 111 E MONUMENT AVE UNIT 324, KISSIMMEE, FL, 347415771, US | 111 E MONUMENT AVE UNIT 324, KISSIMMEE, FL, 347415771, US | |||||||||||||||
|
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| Phone | +1 321-442-0192 |
| Fax | 3213199730 |
Authorized person
| Name | MICHAEL MCGOWAN |
| Role | OWNER |
| Phone | 3214420192 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DESAI, TUSHAAR | Agent | 1916 EAST ROBINSON STREET, ORLANDO, FL 32803 |
| Name | Role | Address |
|---|---|---|
| MCGOWAN, MICHAEL | Managing Member | 100 EAST DAKIN AVENUE, KISSIMMEE, FL 34741 |
| Name | Role | Address |
|---|---|---|
| BARRETT, BRENT | Manager | 100 EAST DAKIN AVENUE, KISSIMMEE, FL 34741 |
| BROWNING, MICHAEL | Manager | 100 EAST DAKIN AVENUE, KISSIMMEE, FL 34741 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-08-11 | 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 | No data |
| CHANGE OF MAILING ADDRESS | 2023-08-11 | 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2022-03-01 |
| Florida Limited Liability | 2021-02-25 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
