| Entity Name: | JACKSONVILLE AUTISM CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 May 2021 (4 years ago) |
| Document Number: | L21000199179 |
| FEI/EIN Number | 86-3724968 |
| Address: | 9000 SOUTHSIDE BLVD BLGD 900, JACKSONVILLE, FL, 32256, US |
| Mail Address: | 9000 SOUTHSIDE BLVD BLGD 900, JACKSONVILLE, FL, 32256, US |
| ZIP code: | 32256 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265016927 | 2021-05-10 | 2022-01-26 | 9000 SOUTHSIDE BLVD BLDG 900, JACKSONVILLE, FL, 322560791, US | 9000 SOUTHSIDE BLVD BLDG 900, JACKSONVILLE, FL, 322560791, US | |||||||||||||||||||||
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| Phone | +1 904-732-4343 |
Authorized person
| Name | MRS. HELEN MICHELLE DUNHAM |
| Role | EXECUTIVE DIRECTOR |
| Phone | 9047324343 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| DUNHAM MICHELLE | Agent | 9000 SOUTHSIDE BLVD BLGD 900, JACKSONVILLE, FL, 32256 |
| Name | Role | Address |
|---|---|---|
| DUNHAM MICHELLE | Chief Executive Officer | 9000 SOUTHSIDE BLVD BLGD 900, JACKSONVILLE, FL, 32256 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-10 |
| ANNUAL REPORT | 2022-01-24 |
| Florida Limited Liability | 2021-05-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
