| Entity Name: | NORTH FLORIDA SLEEP RESOURCES, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Oct 2022 (2 years ago) |
| Document Number: | L22000427844 |
| FEI/EIN Number | 92-0676394 |
| Address: | 1700 EAGLE HARBOR PARKWAY, FLEMING ISLAND, FL, 32003, US |
| Mail Address: | 1700 EAGLE HARBOR PARKWAY, FLEMING ISLAND, FL, 32003, US |
| ZIP code: | 32003 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033835723 | 2022-10-14 | 2024-01-10 | 1700 EAGLE HARBOR PKWY, FLEMING ISLAND, FL, 320038329, US | 1700 EAGLE HARBOR PKWY, FLEMING ISLAND, FL, 320038329, US | |||||||||||||||||||
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| Phone | +1 904-906-6007 |
| Fax | 9042806658 |
Authorized person
| Name | KELLY STANDISH-MAYO |
| Role | DENTIST |
| Phone | 9045053311 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| Is Primary | Yes |
| Taxonomy Code | 332BC3200X - Customized Equipment (DME) |
| Is Primary | No |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH FLORIDA SLEEP RESOURCES, PLLC 401(K) PLAN | 2023 | 920676394 | 2024-05-17 | NORTH FLORIDA SLEEP RESOURCES, PLLC | 0 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-17 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MAYO MAX A | Agent | 5295 COUNTY ROAD 209 SOUTH, GREEN COVE SPRINGS, FL, 32043 |
| Name | Role | Address |
|---|---|---|
| STANDISH-MAYO KELLY T | Manager | 5295 COUNTY ROAD 209 SOUTH, GREEN COVE SPRINGS, FL, 32043 |
| Name | Role | Address |
|---|---|---|
| Mayo Max A | Auth | 5295 County Road 209 S, Green Cove Springs, FL, 32043 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-16 | 1700 EAGLE HARBOR PARKWAY, FLEMING ISLAND, FL 32003 | No data |
| CHANGE OF MAILING ADDRESS | 2022-11-16 | 1700 EAGLE HARBOR PARKWAY, FLEMING ISLAND, FL 32003 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-02-06 |
| Florida Limited Liability | 2022-10-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
