| Entity Name: | LEAD, EMPOWERED, SET, MENTAL HEALTH SERVICES,LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Dec 2022 (2 years ago) |
| Document Number: | L22000524334 |
| FEI/EIN Number | 88-4406512 |
| Address: | 13328 meadowfield dr, orlando, FL 32824 |
| Mail Address: | 13328 meadowfield dr, orlando, FL 32824 |
| ZIP code: | 32824 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487368569 | 2023-01-12 | 2024-01-02 | 6925 LAKE ELLENOR DR STE 120, ORLANDO, FL, 328094648, US | 6925 LAKE ELLENOR DR STE 120, ORLANDO, FL, 328094648, US | |||||||||||||||||||
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| Phone | +1 407-552-5444 |
Authorized person
| Name | DIANA ABRIL MEDINA |
| Role | CLINICAL DIRECTOR |
| Phone | 4073011845 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 116781200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ABRIL MEDINA, DIANA C | Agent | 6925 Lake Ellenor Drive, Suite 120, Orlando, FL 32809 |
| Name | Role | Address |
|---|---|---|
| ABRIL MEDINA, DIANA C | Manager | 6925 Lake Ellenor Drive, Suite 120, Orlando 32809 UN |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-06-06 | 13328 meadowfield dr, orlando, FL 32824 | No data |
| CHANGE OF MAILING ADDRESS | 2024-06-06 | 13328 meadowfield dr, orlando, FL 32824 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-18 | 6925 Lake Ellenor Drive, Suite 120, Orlando, FL 32809 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-18 |
| ANNUAL REPORT | 2023-04-28 |
| Florida Limited Liability | 2022-12-14 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
