| Entity Name: | BLOSSOM MINDS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Sep 2022 (2 years ago) |
| Document Number: | L22000391116 |
| FEI/EIN Number | 92-0253241 |
| Address: | 2645 EXECUTIVE PARK DR, WESTON, FL, 33331, US |
| Mail Address: | 3755 OAK RIDGE CIR, WESTON, FL, 33331 |
| ZIP code: | 33331 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1871217620 | 2022-09-26 | 2022-09-26 | 2645 EXECUTIVE PARK DR STE 534, WESTON, FL, 333313624, US | 2645 EXECUTIVE PARK DR STE 534, WESTON, FL, 333313624, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 954-512-4827 |
Authorized person
| Name | MARIA CORUJO FEIJOO |
| Role | CLINICAL DIRECTOR |
| Phone | 9545124827 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1164975355 |
| State | FL |
| Name | Role |
|---|---|
| SILVAS FINANCIAL SERVICES, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| CORUJO MARIA | Managing Member | 3755 OAK RIDGE CIR, WESTON, FL, 33331 |
| AULINO MILAGROS | Managing Member | 3755 OAK RIDGE CIR, WESTON, FL, 33331 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-27 | 2645 EXECUTIVE PARK DR, STE 534, WESTON, FL 33331 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-03-27 | SILVAS FINANCIAL SERVICES, LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-27 | 5220 S UNIVERSITY DR, STE C-102, DAVIE, FL 33328 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-02 |
| ANNUAL REPORT | 2023-03-27 |
| Florida Limited Liability | 2022-09-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
