| Entity Name: | KETAMINE WELLNESS INSTITUTE OF JACKSONVILLE BEACH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Jan 2022 (3 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 08 Sep 2022 (2 years ago) |
| Document Number: | L22000029840 |
| FEI/EIN Number | 87-4686472 |
| Address: | 1361 13TH AVE S, SUITE 140, JACKSONVILLE BEACH, FL 32250 |
| Mail Address: | 1361 13TH AVE S, SUITE 140, JACKSONVILLE BEACH, FL 32250 |
| ZIP code: | 32250 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487471918 | 2024-09-25 | 2024-09-25 | 1361 13TH AVE S STE 140, JACKSONVILLE BEACH, FL, 322503263, US | 1361 13TH AVE S STE 140, JACKSONVILLE BEACH, FL, 322503263, US | |||||||||||||
|
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| Phone | +1 904-373-8153 |
Authorized person
| Name | SATHAVARAM REDDY |
| Role | OWNER |
| Phone | 9043738153 |
Taxonomy
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| THE LAW OFFICES OF STEPHEN F. DIFATO PLLC | Agent | 164 PINEHURST POINTE DRIVE, ST. AUGUSTINE, FL 32092 |
| Name | Role | Address |
|---|---|---|
| REDDY, SATHAVARAM ARAVIND | Managing Member | 164 PINEHURST POINTE DRIVE, ST. AUGUSTINE, FL 32092 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2022-09-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-09-08 | 1361 13TH AVE S, SUITE 140, JACKSONVILLE BEACH, FL 32250 | No data |
| CHANGE OF MAILING ADDRESS | 2022-09-08 | 1361 13TH AVE S, SUITE 140, JACKSONVILLE BEACH, FL 32250 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-18 |
| ANNUAL REPORT | 2023-03-11 |
| LC Amendment | 2022-09-08 |
| Florida Limited Liability | 2022-01-14 |
Date of last update: 13 Jan 2025
Sources: Florida Department of State
