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REVITALIZING LIFESTYLE MEDICINE LLC - Florida Company Profile

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Company Details

Entity Name: REVITALIZING LIFESTYLE MEDICINE LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 25 Feb 2021 (5 years ago)
Document Number: L21000093710
FEI/EIN Number 863170574
Address: 111 E. Monument Ave. Suite 324, KISSIMMEE, FL, 34741, US
Mail Address: 111 E. Monument Ave. Suite 324, KISSIMMEE, FL, 34741, US
ZIP code: 34741
City: Kissimmee
County: Osceola
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
MCGOWAN MICHAEL Managing Member 100 EAST DAKIN AVENUE, KISSIMMEE, FL, 34741
BARRETT BRENT Manager 100 EAST DAKIN AVENUE, KISSIMMEE, FL, 34741
BROWNING MICHAEL Manager 100 EAST DAKIN AVENUE, KISSIMMEE, FL, 34741
DESAI TUSHAAR Agent 1916 EAST ROBINSON STREET, ORLANDO, FL, 32803

National Provider Identifier

NPI Number:
1598542763
Certification Date:
2023-11-13

Authorized Person:

Name:
MICHAEL MCGOWAN
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

Fax:
3213199730

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-08-11 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 -
CHANGE OF MAILING ADDRESS 2023-08-11 111 E. Monument Ave. Suite 324, KISSIMMEE, FL 34741 -

Documents

Name Date
ANNUAL REPORT 2024-02-20
ANNUAL REPORT 2023-02-03
ANNUAL REPORT 2022-03-01
Florida Limited Liability 2021-02-25

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Date of last update: 01 Aug 2025

Sources: Florida Department of State