| Entity Name: | LIVINGWELL COMPREHENSIVE MEDICAL & PSYCHIATRIC CARE |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Jul 2021 (4 years ago) |
| Document Number: | L21000329706 |
| FEI/EIN Number | 87-1836203 |
| Address: | 7401 Wiles Rd, CORAL SPRINGS, FL, 33067, US |
| Mail Address: | 10240 BREEZEWAY PLACE, BOCA RATON, FL, 33428, US |
| ZIP code: | 33067 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841920105 | 2022-06-10 | 2023-11-16 | PO BOX 970788, BOCA RATON, FL, 334970788, US | 4651 N STATE ROAD 7 STE 9, COCONUT CREEK, FL, 330734378, US | |||||||||||||||||||||||||
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| Phone | +1 954-807-3160 |
| Fax | 5613707906 |
Authorized person
| Name | JEAN-LESLY RIGAUD |
| Role | CEO |
| Phone | 9548073160 |
Taxonomy
| 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 | 117534300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RIGAUD JEAN-LESLY DR | Agent | 10240 BREEZEWAY PLACE, BOCA RATON, FL, 33428 |
| Name | Role | Address |
|---|---|---|
| RIGAUD JEAN LESLY DR | Director | 10240 BREEZEWAY PLACE, BOCA RATON, FL, 33428 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000131936 | LIVINGWELL PSYCHIATRY & WELLNESS | ACTIVE | 2023-10-25 | 2028-12-31 | No data | 10240 BREEZEWAY PLACE, BOCA RATON, FL, 33428--585 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-07 | 7401 Wiles Rd, Suite 222, CORAL SPRINGS, FL 33067 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-07 |
| AMENDED ANNUAL REPORT | 2023-10-25 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-05-28 |
| Florida Limited Liability | 2021-07-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
