Entity Name: | ELITE RELIEF MD PLLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Co. |
Status: | Active |
Date Filed: | 27 Nov 2023 (a year ago) |
Document Number: | L23000522479 |
FEI/EIN Number | 93-4566592 |
Address: | 7740 NOVA DR, B4, DAVIE, FL, 33324 |
Mail Address: | 7740 NOVA DR, B4, DAVIE, FL, 33324 |
ZIP code: | 33324 |
County: | Broward |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1447029947 | 2023-12-26 | 2024-03-21 | 7740 NOVA DR STE B4, DAVIE, FL, 333245802, US | 7740 NOVA DR STE B4, DAVIE, FL, 333245802, US | |||||||||||||||
|
Phone | +1 754-200-6410 |
Fax | 7542006411 |
Authorized person
Name | KELLY U DESOUZA |
Role | PHYSICIAN |
Phone | 7542006410 |
Taxonomy
Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
Is Primary | Yes |
Name | Role | Address |
---|---|---|
GADDY STEVEN H | Agent | 7740 Nova Dr, Davie, FL, 33324 |
Name | Role | Address |
---|---|---|
Kelly Desouza Gaddy Revocable Trust | Manager | 7740 NOVA DR #B4, DAVIE, FL, 33324 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
REGISTERED AGENT ADDRESS CHANGED | 2024-02-05 | 7740 Nova Dr, B4, Davie, FL 33324 | No data |
Name | Date |
---|---|
ANNUAL REPORT | 2024-02-05 |
Florida Limited Liability | 2023-11-27 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State