| Entity Name: | THE BLUE DOOR INFANT AND MATERNAL WELLNESS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 08 Jan 2024 (a year ago) |
| Last Event: | LC NAME CHANGE |
| Event Date Filed: | 23 Jul 2024 (6 months ago) |
| Document Number: | L24000018218 |
| Address: | 3030 STARKEY BLVD, NEW PORT RICHEY, FL 34655 |
| Mail Address: | 3030 STARKEY BLVD, NEW PORT RICHEY, FL 34655 |
| ZIP code: | 34655 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992569040 | 2024-02-08 | 2024-08-08 | 19103 BECKETT DR, ODESSA, FL, 335562266, US | 3030 STARKEY BLVD STE 272, NEW PORT RICHEY, FL, 346552175, US | |||||||||||||||||||||||
|
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| Phone | +1 330-445-9006 |
Authorized person
| Name | RACHEL BENDER |
| Role | SPEECH LANGUAGE PATHOLOGIST |
| Phone | 3394459006 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1124806740 |
| State | FL |
| Name | Role |
|---|---|
| UNITED STATES CORPORATION AGENTS, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| HAWKS, ALEXIS | Authorized Member | 3030 STARKEY BLVD, NEW PORT RICHEY, FL 34655 |
| BENDER, RACHEL | Authorized Member | 3030 STARKEY BLVD, NEW PORT RICHEY, FL 34655 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC NAME CHANGE | 2024-07-23 | THE BLUE DOOR INFANT AND MATERNAL WELLNESS LLC | No data |
| Name | Date |
|---|---|
| LC Name Change | 2024-07-23 |
| Florida Limited Liability | 2024-01-08 |
Date of last update: 08 Jan 2025
Sources: Florida Department of State
