| Entity Name: | MINDSET & RECOVERY DIVERSIFIED LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 11 Aug 2023 (a year ago) |
| Document Number: | L23000379037 |
| FEI/EIN Number | 932888988 |
| Address: | 11582 SW VILLAGE PKWY, 1262, PORT ST LUCIE, FL, 34987, US |
| Mail Address: | 11582 SW VILLAGE PKWY, 1262, PORT ST LUCIE, FL, 34987, US |
| ZIP code: | 34987 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1518792365 | 2024-09-03 | 2024-09-03 | 11582 SW VILLAGE PKWY # 1262, PORT ST LUCIE, FL, 349872392, US | 6633 WOODS ISLAND CIR APT 206, PORT ST LUCIE, FL, 349521475, US | |||||||||||||||
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| Phone | +1 772-208-8734 |
| Fax | 7726675186 |
Authorized person
| Name | KHATRIENA D JOHNSON |
| Role | PMHNP-BC |
| Phone | 7722088734 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JOHNSON KHATRIENA D | Agent | 6633 WOODS ISLAND CIR, PORT ST LUCIE, FL, 34952 |
| Name | Role | Address |
|---|---|---|
| JOHNSON KHATRIENA D | Manager | 11582 SW VILLAGE PKWY #1262, PORT ST LUCIE, FL, 34987 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-09-05 | 11582 SW VILLAGE PKWY, 1262, PORT ST LUCIE, FL 34987 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-19 |
| Florida Limited Liability | 2023-08-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
