| Entity Name: | GENESIS BRAIN INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Sep 2022 (2 years ago) |
| Document Number: | L22000390412 |
| FEI/EIN Number | 88-4057240 |
| Address: | 3030 NORTH ROCKY POINT DRIVE W, SUITE 660, TAMPA, FL, 33607, US |
| Mail Address: | 3030 NORTH ROCKY POINT DRIVE W, SUITE 665, TAMPA, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104547322 | 2022-09-06 | 2022-09-06 | 3030 N ROCKY POINT DR W STE 665, TAMPA, FL, 336075906, US | 3030 N ROCKY POINT DR W STE 665, TAMPA, FL, 336075906, US | |||||||||||||
|
|||||||||||||||||
| Phone | +1 727-784-8600 |
Authorized person
| Name | RENEE D KELLY |
| Role | ADMINISTRATOR |
| Phone | 7277848600 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| HECKROTH GREGORY | Agent | 3030 NORTH ROCKY POINT DRIVE W, TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| HECKROTH GREGORY | Manager | 3030 NORTH ROCKY POINT DRIVE W, SUITE 665, TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| Nixon Samuel | Auth | 3030 North Rocky Point Drive W, Tampa, FL, 33607 |
| Kelly Renee | Auth | 3030 North Rocky Point Drive W, Tampa, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-03 | 3030 NORTH ROCKY POINT DRIVE W, SUITE 660, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| AMENDED ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2023-01-03 |
| Florida Limited Liability | 2022-09-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
