| Entity Name: | ELITE MINDFUL HEALTH PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Jul 2022 (3 years ago) |
| Document Number: | L22000316232 |
| FEI/EIN Number | 88-3372516 |
| Address: | 11327 Okeechobee Blvd, Suite 2 & 3, Royal Palm Beach, FL 33411 |
| Mail Address: | 11327 Okeechobee Blvd, Ste 2 & 3, Royal Palm Beach, FL 33411 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396453999 | 2022-11-11 | 2022-11-18 | 11327 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL, 334118724, US | 11327 OKEECHOBEE BLVD, ROYAL PALM BEACH, FL, 334118724, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 561-425-9114 |
| Fax | 5614492978 |
Authorized person
| Name | DR. LOUISE AURELIEN BUIE |
| Role | CEO |
| Phone | 5617040480 |
Taxonomy
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105597000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Aurelien Buie, Louise | Agent | 11327 Okeechobee Blvd, Ste 2 & 3, West Palm Beach, FL 33411 |
| Name | Role | Address |
|---|---|---|
| Aurelien Buie, Louise | Authorized Member | 4098 Winnipeg Way, West Palm Beach, FL 33409 |
| Name | Role | Address |
|---|---|---|
| Buie, Willie Jethro, Jr. | Manager | 11327 Okeechobee Blvd, Ste 2 & 3 Royal Palm Beach, FL 33411 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2025-01-21 | 11327 Okeechobee Blvd, Suite 2 & 3, Royal Palm Beach, FL 33411 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2025-01-21 | 11327 Okeechobee Blvd, Ste 2 & 3, West Palm Beach, FL 33411 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-18 | 11327 Okeechobee Blvd, Suite 2 & 3, Royal Palm Beach, FL 33411 | No data |
| CHANGE OF MAILING ADDRESS | 2023-07-18 | 11327 Okeechobee Blvd, Suite 2 & 3, Royal Palm Beach, FL 33411 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-07-18 | Aurelien Buie, Louise | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-07-18 | 4098 Winnipeg Way, West Palm Beach, FL 33409 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-03-08 |
| AMENDED ANNUAL REPORT | 2023-07-18 |
| ANNUAL REPORT | 2023-03-08 |
| Florida Limited Liability | 2022-07-15 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
