| Entity Name: | KETAMINE WELLNESS CENTERS JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Nov 2020 (4 years ago) |
| Date of dissolution: | 13 Dec 2024 (a month ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 13 Dec 2024 (a month ago) |
| Document Number: | M20000010375 |
| FEI/EIN Number | 85-3704829 |
| Address: | 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL 32257 |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | ARIZONA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063016988 | 2020-11-23 | 2020-11-23 | 113 W HOOVER AVE STE 101, MESA, AZ, 852105214, US | 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL, 322575582, US | |||||||||||||||
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| Phone | +1 855-538-9355 |
| Fax | 8445389355 |
Authorized person
| Name | MS. ANITA JERGER |
| Role | EXECUTIVE ASSISTANT |
| Phone | 8555389355 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BLACK, BARBARA | Agent | 3753-2 CARDINAL POINT DR, JACKSONVILLE, FL 32257 |
| Name | Role | Address |
|---|---|---|
| KETAMINE WELLNESS CENTERS ARIZONA | Member | 491 N 159 PL, GILBERT, AZ 85234 |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, JULIE | Manager | 491 N 159 PL, GILBERT, AZ 85234 |
| NICHOLAS, KEVIN | Manager | 491 N 159 PL, GILBERT, AZ 85234 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2024-12-13 | No data | No data |
| REVOKED FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| Name | Date |
|---|---|
| WITHDRAWAL | 2024-12-13 |
| AMENDED ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-02-25 |
| Foreign Limited | 2020-11-12 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
