| Entity Name: | GROW WELL ABA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 11 Oct 2021 (3 years ago) |
| Document Number: | L21000442688 |
| FEI/EIN Number | 85-0891963 |
| Address: | 10630 Waterfield Rd, JACKSONVILLE, FL 32210 |
| Mail Address: | 10630 Waterfield Rd, JACKSONVILLE, FL 32210 |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821619438 | 2020-05-05 | 2024-06-21 | 3402 PARSON CT FL 32223, JACKSONVILLE, FL, 322237337, US | 3402 PARSON CT, JACKSONVILLE, FL, 322237337, US | |||||||||||||||||||||||||||
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| Phone | +1 904-323-1782 |
| Phone | +1 904-434-0785 |
Authorized person
| Name | MS. HELENA DANEA JENKINS |
| Role | OWNER |
| Phone | 9044340785 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1245735711 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1821619438 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JENKINS, HELENA D | Agent | 3402 PARSON CT, JACKSONVILLE, FL 32223 |
| Name | Role | Address |
|---|---|---|
| JENKINS, HELENA D | Chief Executive Officer | 10630 WATERFIELD RD, JACKSONVILLE, FL 32210 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-19 | 10630 Waterfield Rd, JACKSONVILLE, FL 32210 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-19 | 10630 Waterfield Rd, JACKSONVILLE, FL 32210 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-11 |
| Florida Limited Liability | 2021-10-11 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
