| Entity Name: | EDEN MEDICAL SUPPLY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Jun 2022 (3 years ago) |
| Last Event: | LC AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 14 Jun 2022 (3 years ago) |
| Document Number: | L22000270338 |
| FEI/EIN Number | 85-1380012 |
| Address: | 7300 N. Federal Hwy Suite 102, BOCA RATON, FL, 33487, US |
| Mail Address: | 7300 N. Federal Hwy Suite 102, BOCA RATON, FL, 33487, US |
| ZIP code: | 33487 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598381212 | 2020-06-18 | 2024-04-01 | 7300 N FEDERAL HWY STE 102, BOCA RATON, FL, 334871631, US | 7300 N FEDERAL HWY STE 102, BOCA RATON, FL, 334871631, US | |||||||||||||||||||
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| Phone | +1 800-838-3560 |
| Fax | 8665893366 |
Authorized person
| Name | MR. MICHAEL MASCIARELLA |
| Role | DIRECTOR OF BUSINESS DEVELOPMENT/CE |
| Phone | 8008383560 |
Taxonomy
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | HUMANA |
| Number | HUMANA |
| Name | Role | Address |
|---|---|---|
| MASCIARELLA MICHAEL | Agent | 770 NE 69TH STREET, BOCA RATON, FL, 33487 |
| Name | Role | Address |
|---|---|---|
| MASCIARELLA MICHAEL | Manager | 770 NE 69TH STREET, BOCA RATON, FL, 33487 |
| ALARCON SCOTT | Manager | 770 NE 69TH STREET, BOCA RATON, FL, 33487 |
| ALARCON TRISTIAN | Manager | 355 E OHIO STREET #3209, CHICAGO, IL, 60611 |
| ALARCON KATHY | Manager | 7300 N. Federal Hwy Suite 102, BOCA RATON, FL, 33487 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-23 | 7300 N. Federal Hwy Suite 102, BOCA RATON, FL 33487 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-23 | 7300 N. Federal Hwy Suite 102, BOCA RATON, FL 33487 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-23 | 770 NE 69TH STREET, BOCA RATON, FL 33487 | No data |
| CONVERSION | 2022-06-14 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS. CONVERSION NUMBER 700000227377 |
| LC AMENDMENT AND NAME CHANGE | 2022-06-14 | EDEN MEDICAL SUPPLY LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-05 |
| ANNUAL REPORT | 2023-01-23 |
| Florida Limited Liability | 2022-06-14 |
| LC Amendment and Name Change | 2022-06-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
