| Entity Name: | ELLEORHIM MENTAL WELLBEING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jul 2021 (4 years ago) |
| Document Number: | L21000307052 |
| FEI/EIN Number | 87-1837722 |
| Address: | 20523 NW 8TH AVE, MIAMI GARDENS, 33169, FL |
| Mail Address: | P O BOX 695241, MIAMI GARDENS, FL, 33269, US |
| ZIP code: | 33169 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013670025 | 2021-10-17 | 2024-08-30 | 20523 NW 8TH AVE, MIAMI GARDENS, FL, 331692381, US | 6115 STIRLING RD STE 215, DAVIE, FL, 333147240, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 786-223-1744 |
| Fax | 7869304046 |
Authorized person
| Name | MRS. MARIE CARLINE OSEH |
| Role | PMHNP |
| Phone | 7862231744 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1417406026 |
| State | FL |
| Issuer | 1417406026 |
| Number | 1417406026 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| OSEH MARIE C | Agent | 20523 NW 8TH AVE, MIAMI GARDENS, FL, 33169 |
| Name | Role | Address |
|---|---|---|
| OSEH MARIE C | Manager | 20523 NW 8TH AVE, MIAMI GARDENS, FL, 33169 |
| OSEH AUSTIN | Manager | 20523 NW 8TH AVE, MIAMI GARDENS, FL, 33169 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-06-02 |
| Florida Limited Liability | 2021-07-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
