| Entity Name: | LAKESIDE CLINIC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Oct 2015 (9 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 25 Jul 2022 (3 years ago) |
| Document Number: | M15000008040 |
| FEI/EIN Number | 47-5239718 |
| Address: | 1720 Lakepointe Drive, Suite 117, Lewisville, TX, 75057, US |
| Mail Address: | 1720 Lakepointe Drive, Suite 117, Lewisville, TX, 75057, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992162879 | 2016-01-22 | 2024-07-29 | 1720 LAKEPOINTE DR STE 117, LEWISVILLE, TX, 750576425, US | 13700 58TH ST N, BUILDING 2, SUITE 201, CLEARWATER, FL, 337603757, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 469-470-4779 |
| Phone | +1 727-223-3545 |
Authorized person
| Name | BRUCE JARVIE |
| Role | VP, TREASURER |
| Phone | 2143793300 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM2800X - Methadone Clinic |
| Is Primary | Yes |
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| CT CORPORATION SYSTEM | Agent | 1200 S PINE ISLAND RD, PLANTATION, FL, 33324 |
| Name | Role |
|---|---|
| RIVERWOOD GROUP LLC | Member |
| Name | Role | Address |
|---|---|---|
| Saul Mike | Vice President | 1720 Lakepointe Drive, Lewisville, TX, 75057 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000030093 | MEDMARK TREATMENT CENTERS CLEARWATER | ACTIVE | 2022-04-04 | 2027-12-31 | No data | 1720 LAKEPOINTE DR, SUITE 117, LEWISVILLE, TX, 75057 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-15 | 1720 Lakepointe Drive, Suite 117, Lewisville, TX 75057 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-15 | 1720 Lakepointe Drive, Suite 117, Lewisville, TX 75057 | No data |
| LC AMENDMENT | 2022-07-25 | No data | No data |
| LC STMNT OF RA/RO CHG | 2022-02-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-02-25 | CT CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-25 | 1200 S PINE ISLAND RD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-15 |
| ANNUAL REPORT | 2023-02-23 |
| LC Amendment | 2022-07-25 |
| ANNUAL REPORT | 2022-05-18 |
| CORLCRACHG | 2022-02-25 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-01-31 |
| ANNUAL REPORT | 2019-02-05 |
| ANNUAL REPORT | 2018-02-02 |
| ANNUAL REPORT | 2017-02-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
