| Entity Name: | AMPLIFIED VITALITY WELLNESS CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Dec 2022 (2 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 12 Sep 2023 (a year ago) |
| Document Number: | L22000515758 |
| FEI/EIN Number | 92-1606392 |
| Address: | 312 NE 26TH ST, WINTON MANORS, FL 33305 |
| Mail Address: | 312 NE 26TH ST, WINTON MANORS, FL 33305 |
| ZIP code: | 33305 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255045209 | 2023-01-12 | 2023-01-12 | 312 NE 26TH ST, WILTON MANORS, FL, 333051137, US | 3401 N DIXIE HWY, OAKLAND PARK, FL, 333342839, US | |||||||||||||||
|
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| Phone | +1 603-303-3660 |
| Phone | +1 954-667-3385 |
Authorized person
| Name | DR. CHRISTOPHER PAUL LACROSS |
| Role | MEDICAL DIRECTOR |
| Phone | 6033033660 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BROCK SLATER | Agent | 312 NE 26TH ST, WINTON MANORS, FL 33305 |
| Name | Role | Address |
|---|---|---|
| LACROSS, CHRISTOPHER P | Manager | 312 NE 26TH ST, WILTON MANORS, FL 33305 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000031579 | AMP CLINIC | ACTIVE | 2024-02-29 | 2029-12-31 | No data | 312 NORTHEAST 26TH STREET, WILTON MANORS, FL, 33305 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2023-09-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-09-12 | 312 NE 26TH ST, WINTON MANORS, FL 33305 | No data |
| CHANGE OF MAILING ADDRESS | 2023-09-12 | 312 NE 26TH ST, WINTON MANORS, FL 33305 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-09-12 | BROCK SLATER | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-09-12 | 312 NE 26TH ST, WINTON MANORS, FL 33305 | No data |
| LC STMNT CORR/NC | 2022-12-19 | AMPLIFIED VITALITY WELLNESS CLINIC, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-18 |
| ANNUAL REPORT | 2024-02-22 |
| CORLCRACHG | 2023-09-12 |
| CORLCSTCNC | 2022-12-19 |
| Florida Limited Liability | 2022-12-08 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
