| Entity Name: | JCW WELLNESS CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Sep 2024 (5 months ago) |
| Document Number: | L24000388476 |
| FEI/EIN Number | 994852200 |
| Mail Address: | 19812 SW 121ST AVE, MIAMI, FL, 33177, US |
| Address: | 7392 NW 35TH TERRRACE, SUITE 303, MIAMI, FL, 33122, US |
| ZIP code: | 33122 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134947138 | 2024-09-30 | 2024-10-01 | 7392 NW 35TH TER STE 303, MIAMI, FL, 331221260, US | 7392 NW 35TH TER STE 303, MIAMI, FL, 331221260, US | |||||||||||||
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| Phone | +1 786-424-8589 |
Authorized person
| Name | WISLEY CASANOVA MORENO |
| Role | OWNER |
| Phone | 7866952202 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| CANOVAS MORENO WISLEY | Agent | 19812 SW 121ST AVE, MIAMI, FL, 33177 |
| Name | Role | Address |
|---|---|---|
| CANOVAS MORENO WISLEY | Authorized Member | 19812 SW 121ST AVE, MIAMI, FL, 33177 |
| MATA RIEUMONT SUAD D | Authorized Member | 4571 SW 127TH CT, MIAMI, FL, 33175 |
| Name | Date |
|---|---|
| Florida Limited Liability | 2024-09-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
