| Entity Name: | MENTAL ALIVE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 21 Jul 2022 (3 years ago) |
| Document Number: | L22000323594 |
| FEI/EIN Number | 88-3391287 |
| Address: | 1260 Northlake Blvd, Suite 1029, Lake Park, FL, 33403, US |
| Mail Address: | 1260 Northlake Blvd, Suite 1029, Lake Park, FL, 33403, US |
| ZIP code: | 33403 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780310508 | 2022-07-25 | 2022-07-28 | 1260 NORTHLAKE BLVD # 1034, LAKE PARK, FL, 334032050, US | 13932 85TH RD N, WEST PALM BEACH, FL, 334122669, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 561-770-8418 |
| Fax | 5617268771 |
Authorized person
| Name | MARGUERITE JOSEPH |
| Role | PMHNP-BC |
| Phone | 5613319428 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JOSEPH MARGUERITE | Agent | 1260 Northlake Blvd, Lake Park, FL, 33403 |
| Name | Role | Address |
|---|---|---|
| Joseph Marguerite | Authorized Member | 1260 Northlake Blvd, Lake Park, FL, 33403 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-29 | 1260 Northlake Blvd, Suite 1029, Lake Park, FL 33403 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-29 | 1260 Northlake Blvd, Suite 1029, Lake Park, FL 33403 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-29 | 1260 Northlake Blvd, Suite 1029, Lake Park, FL 33403 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-06 |
| Florida Limited Liability | 2022-07-21 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
