| Entity Name: | PROVIDERS FOR HEALTHY LIVING II, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Mar 2021 (4 years ago) |
| Document Number: | L21000136949 |
| FEI/EIN Number | 86-2565047 |
| Address: | 341 N Maitland Ave Ste 340, Maitland, FL, 32751, US |
| Mail Address: | 341 N Maitland Ave Ste 340, Maitland, FL, 32751, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417536145 | 2021-04-08 | 2023-08-24 | 341 N MAITLAND AVE STE 340, MAITLAND, FL, 327514761, US | 341 N MAITLAND AVE STE 340, MAITLAND, FL, 327514761, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 407-219-3281 |
| Fax | 6146643595 |
| Fax | 4072193281 |
Authorized person
| Name | DR. MATTHEW LOWE |
| Role | CEO |
| Phone | 4072193281 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| LOWE MATTHEW | Agent | 341 N Maitland Ave Ste 340, Maitland, FL, 32751 |
| Name | Role | Address |
|---|---|---|
| Lowe Matthew Dr. | Chief Executive Officer | 341 N Maitland Ave Ste 340, Maitland, FL, 32751 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-28 | 341 N Maitland Ave Ste 340, Maitland, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-28 | 341 N Maitland Ave Ste 340, Maitland, FL 32751 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-28 | 341 N Maitland Ave Ste 340, Maitland, FL 32751 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-28 |
| Florida Limited Liability | 2021-03-23 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
