| Entity Name: | KHARIS EPHRATA PSYCHIATRIC SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Feb 2022 (3 years ago) |
| Document Number: | L22000063993 |
| FEI/EIN Number | 88-0764311 |
| Address: | 1030 Wildmeadow Run, Winter Park, FL, 32792, US |
| Mail Address: | 274 Wilshire blvd., 273, Casselberry, FL, 32707, US |
| ZIP code: | 32792 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386393106 | 2022-03-20 | 2022-03-20 | 1030 WILDMEADOW RUN, WINTER PARK, FL, 327923032, US | 1030 WILDMEADOW RUN, WINTER PARK, FL, 327923032, US | |||||||||||||||||||
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| Phone | +1 407-775-0248 |
| Fax | 4079517688 |
Authorized person
| Name | RUBY ODAMTTEN |
| Role | OWNER |
| Phone | 4077750248 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | I DO NOT HAVE SUCH NUMBERS |
| Number | NA |
| Name | Role | Address |
|---|---|---|
| ODAMTTEN RUBY | Agent | 274 Wilshire blvd., Casselberry, FL, 32707 |
| Name | Role | Address |
|---|---|---|
| ODAMTTEN RUBY | Managing Member | 1030 WILDMEADOW RUN, WINTER PARK, 32792 |
| Name | Role | Address |
|---|---|---|
| LEVINE DAVIDA | offi | 274 Wilshire Boulevard, Casselberry, FL, 32707 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-03-01 | 1030 Wildmeadow Run, Winter Park, FL 32792 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-01 | 274 Wilshire blvd., 273, Casselberry, FL 32707 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-02-16 | 1030 Wildmeadow Run, Winter Park, FL 32792 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-01 |
| ANNUAL REPORT | 2023-02-05 |
| Florida Limited Liability | 2022-02-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
