| Entity Name: | DESTINY THERAPEUTIC SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 May 2022 (3 years ago) |
| Document Number: | L22000237181 |
| FEI/EIN Number | 882635088 |
| Address: | 4204 Okeechobee Road, FORT PIERCE, FL, 34947, US |
| Mail Address: | P.O. Box #4043, FORT PIERCE, FL, 34948, US |
| ZIP code: | 34947 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982330353 | 2022-07-28 | 2022-07-28 | 4186 OKEECHOBEE ROAD, SUITE 77, FORT PIERCE, FL, 34947, US | 4186 OKEECHOBEE ROAD, SUITE 77, FORT PIERCE, FL, 34947, US | |||||||||||||||||||||
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| Phone | +1 772-359-1267 |
| Fax | 7722648224 |
Authorized person
| Name | MS. LARONDA CHATMAN |
| Role | OWNER |
| Phone | 7723591267 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 111187900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHATMAN LARONDA M | Agent | 1910 AVENUE Q, FORT PIERCE, FL, 34950 |
| Name | Role | Address |
|---|---|---|
| CHATMAN LARONDA M | Manager | 1910 AVENUE Q, APT A, FORT PIERCE, FL, 34950 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-15 | 4204 Okeechobee Road, FORT PIERCE, FL 34947 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-20 | 4204 Okeechobee Road, FORT PIERCE, FL 34947 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-03-17 |
| Florida Limited Liability | 2022-05-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
