| Entity Name: | FALLING LEAVES RECOVERY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 11 Dec 2015 (9 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | M15000009938 |
| FEI/EIN Number | 475310800 |
| Address: | 5079 N DIXIE HWY, STE. 198, FORT LAUDERDALE, FL, 33334, US |
| Mail Address: | 5079 N DIXIE HWY, STE. 198, FORT LAUDERDALE, FL, 33334, US |
| ZIP code: | 33334 |
| County: | Broward |
| Place of Formation: | NEVADA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346698693 | 2016-05-26 | 2022-07-21 | 5079 N DIXIE HWY, 198, OAKLAND PARK, FL, 333344000, US | 15485 EAGLE NEST LN, SUITE 210 & 230, MIAMI LAKES, FL, 330142247, US | |||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 786-332-2218 |
| Fax | 9543573624 |
| Fax | 7863324994 |
Authorized person
| Name | MARK SHEPPARD |
| Role | CFO |
| Phone | 8322893350 |
Taxonomy
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| License Number | 1302 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| License Number | 1302 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CLIA |
| Number | 10D2122335 |
| State | FL |
| Issuer | BCBS |
| Number | YGC |
| State | FL |
| Issuer | BCBS GROUP ID |
| Number | Z4YG9 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHEPPARD MARK | Agent | 5079 N DIXIE HWY, STE. 198, FORT LAUDERDALE, FL, 33334 |
| Name | Role | Address |
|---|---|---|
| SHEPPARD MARK | Manager | 5079 N DIXIE HWY, STE. 198, FORT LAUDERDALE, FL, 33334 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000130289 | FALLEN LEAVES RECOVERY | EXPIRED | 2015-12-24 | 2020-12-31 | No data | 5679 N. DIXIE HWY., SUITE 198, FORT LAUDERDALE, FL, 33334 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REINSTATEMENT | 2017-11-10 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2016-12-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-12-22 | SHEPPARD, MARK | No data |
| REVOKED FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2017-11-10 |
| REINSTATEMENT | 2016-12-22 |
| Foreign Limited | 2015-12-11 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
