| Entity Name: | LEAF MEDICAL GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 May 2022 (3 years ago) |
| Document Number: | L22000207798 |
| FEI/EIN Number | 88-2136759 |
| Address: | 450 W STATE RD. 434, 2030, LONGWOOD, FL, 32750, UN |
| Mail Address: | 450 W STATE RD. 434, 2030, LONGWOOD, FL, 32750, UN |
| ZIP code: | 32750 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073240016 | 2022-08-01 | 2022-08-01 | 450 W STATE ROAD 434 STE 2030, LONGWOOD, FL, 327505187, US | 450 W STATE ROAD 434 STE 2030, LONGWOOD, FL, 327505187, US | |||||||||||||
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| Phone | +1 407-767-8200 |
Authorized person
| Name | ANDY JORDAN |
| Role | CREDENTIALING |
| Phone | 3212068100 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Moreno Lissette | Agent | 450 W STATE RD. 434, LONGWOOD, FL, 32750 |
| Name | Role | Address |
|---|---|---|
| AHMAR WASIM DR | Chief Executive Officer | 450 W STATE RD. 434, LONGWOOD, FL, 32750 |
| Name | Role | Address |
|---|---|---|
| Moreno Lissette | Admi | 450 West State Road 434, Suite 2030, Longwood, FL, 32750 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000157700 | LEAF CHIROPRACTIC LONGWOOD | ACTIVE | 2022-12-21 | 2027-12-31 | No data | 450 W STATE RD. 434, SUITE 2030, LONGWOOD, FL, 32750 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-02-07 | Moreno, Lissette | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-10 |
| Florida Limited Liability | 2022-05-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
