| Entity Name: | COLLABORATIVE HEALTHCARE SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Apr 2021 (4 years ago) |
| Document Number: | L21000177313 |
| FEI/EIN Number | 86-3553990 |
| Address: | 300 South Pine Island Road, Suite 216, Plantation, FL 33324 |
| Mail Address: | 300 South Pine Island Road, Suite 216, Plantation, FL 33324 |
| ZIP code: | 33324 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902479272 | 2021-07-23 | 2021-07-23 | 2042 CORAL HEIGHTS CT, OAKLAND PARK, FL, 333085223, US | 2042 CORAL HEIGHTS CT, OAKLAND PARK, FL, 333085223, US | |||||||||||||||||||
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| Phone | +1 954-551-8460 |
Authorized person
| Name | DR. BRITTANY MARIE LOVE-COSTELLO |
| Role | LICENSED PSYCHOLOGIST / PRESIDENT |
| Phone | 9545518460 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1588933550 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COSTELLO, BRITTANY | Agent | 1021 NW 101st Way, Plantation, FL 33322 |
| Name | Role | Address |
|---|---|---|
| COSTELLO, BRITTANY M | Manager | 1021 NW 101st Way, Plantation, FL 33322 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-03 | 300 South Pine Island Road, Suite 216, Plantation, FL 33324 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-31 | 300 South Pine Island Road, Suite 216, Plantation, FL 33324 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-23 | 1021 NW 101st Way, Plantation, FL 33322 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-04-23 |
| ANNUAL REPORT | 2022-01-27 |
| Florida Limited Liability | 2021-04-16 |
Date of last update: 14 Jan 2025
Sources: Florida Department of State
