| Entity Name: | LOGOS COMMUNICATION THERAPY SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Jun 2022 (3 years ago) |
| Document Number: | L22000270584 |
| FEI/EIN Number | 88-2856246 |
| Address: | 11 Racetrack Road NE Suite B-4, Fort Walton Beach, FL, 32547, US |
| Mail Address: | 106 BLACK BEAR CIRCLE, NICEVILLE, FL, 32578 |
| ZIP code: | 32547 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366140568 | 2023-02-17 | 2024-11-06 | 106 BLACK BEAR CIR, NICEVILLE, FL, 325781202, US | 106 BLACK BEAR CIRCLE, NICEVILLE, FL, 32578, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-830-3314 |
| Fax | 8509040355 |
Authorized person
| Name | ENRI Y FORT |
| Role | OWNER/PROVIDER |
| Phone | 8508303314 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 118480700 |
| State | FL |
| Issuer | DOH |
| Number | SA18378 |
| State | FL |
| Issuer | MEDICAID |
| Number | 117493600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 117725200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 118599100 |
| State | FL |
| Issuer | ASHA CCC |
| Number | 12030298 |
| State | MD |
| Issuer | FL DOH SLP LICENSE |
| Number | 18378 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FORT ENRI | Agent | 106 BLACK BEAR CIR, NICEVILLE, FL, 32578 |
| Name | Role | Address |
|---|---|---|
| FORT ENRI | Manager | 106 BLACK BEAR CIR, NICEVILLE, FL, 32578 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000020305 | THE SPEECH POD | ACTIVE | 2023-02-12 | 2028-12-31 | No data | 106 BLACK BEAR CIRCLE, NICEVILLE, FL, 32578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-04 | 11 Racetrack Road NE Suite B-4, Fort Walton Beach, FL 32547 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-02-12 |
| Florida Limited Liability | 2022-06-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
