| Entity Name: | KETAMINE WELLNESS CENTER OF FLORIDA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Jan 2023 (2 years ago) |
| Document Number: | L23000010092 |
| FEI/EIN Number | 92-1540625 |
| Address: | 110 N. FEDERAL HWY, 302, HALLANDALE, FL, 33009 |
| Mail Address: | 110 N. FEDERAL HWY, 302, HALLANDALE, FL, 33009, UN |
| ZIP code: | 33009 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235820325 | 2023-05-18 | 2023-05-18 | 110 N FEDERAL HWY STE 302, HALLANDALE BEACH, FL, 330094300, US | 110 N FEDERAL HWY STE 302, HALLANDALE BEACH, FL, 330094300, US | |||||||||||||||||
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| Phone | +1 954-251-2217 |
| Fax | 9543748908 |
| Phone | +1 818-814-1323 |
Authorized person
| Name | RUDOLF BELL |
| Role | MEMBER |
| Phone | 9543676261 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BELL RUDY | Agent | 110 N. FEDERAL HWY, HALLANDALE, FL, 33009 |
| Name | Role | Address |
|---|---|---|
| REZNIK ERIC YPSY.D | Manager | 110 N. FEDERAL HWY 302, HALLANDALE, FL, 33009 |
| BELL RUDOLF F | Manager | 110 N. FEDERAL HWY 302, HALLANDALE, FL, 33009 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| Florida Limited Liability | 2023-01-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
