| Entity Name: | DIVINE TELEHEALTH SERVICES LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Apr 2023 (2 years ago) |
| Document Number: | L23000173473 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 6982 LAKESIDE RD., WEST PALM BEACH, FL, 33411 |
| Mail Address: | 6982 LAKESIDE RD., WEST PALM BEACH, FL, 33411 |
| ZIP code: | 33411 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750065025 | 2023-06-14 | 2023-06-14 | 6982 LAKESIDE RD, WEST PALM BEACH, FL, 334112624, US | 6982 LAKESIDE RD, WEST PALM BEACH, FL, 334112624, US | |||||||||||||
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| Phone | +1 561-349-5001 |
Authorized person
| Name | LAVERNE MITCHELL |
| Role | CEO |
| Phone | 5613495001 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| MITCHELL LAVERNE | Agent | 6982 LAKESIDE RD., WEST PALM BEACH, FL, 33411 |
| Name | Role | Address |
|---|---|---|
| MITCHELL LAVERNE | Manager | 6982 LAKESIDE RD., WEST PALM BEACH, FL, 33411 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| Florida Limited Liability | 2023-04-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
