| Entity Name: | VITALITY INTEGRATED MEDICAL NETWORK, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 May 2023 (2 years ago) |
| Document Number: | M23000006826 |
| FEI/EIN Number | 931450714 |
| Address: | 275 18th Street, Vero Beach, FL, 32960, US |
| Mail Address: | 275 18th Street, Vero Beach, FL, 32960, US |
| ZIP code: | 32960 |
| County: | Indian River |
| Place of Formation: | WYOMING |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366136814 | 2023-06-07 | 2024-02-02 | PO BOX 8929, CORAL SPRINGS, FL, 330758929, US | 275 18TH ST STE 102, VERO BEACH, FL, 329600824, US | |||||||||||||||||||||||||||
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| Phone | +1 772-562-6818 |
| Fax | 7722993653 |
Authorized person
| Name | ALLEN LICHT |
| Role | MANAGING DIRECTOR |
| Phone | 9549069536 |
Taxonomy
| Taxonomy Code | 207RG0100X - Gastroenterology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207RR0500X - Rheumatology Physician |
| Is Primary | No |
| Taxonomy Code | 261QI0500X - Infusion Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
| Name | Role |
|---|---|
| SOUTH FLORIDA MEDICAL ASSOCIATES LLC | Agent |
| Name | Role | Address |
|---|---|---|
| LICHT ALLEN | Manager | 275 18th Street, Vero Beach, FL, 32960 |
| Name | Role |
|---|---|
| SOUTH FLORIDA MEDICAL ASSOCIATES LLC | Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-01 | 275 18th Street, Suite 102, Vero Beach, FL 32960 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-01 | 275 18th Street, Suite 102, Vero Beach, FL 32960 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-05-01 | SOUTH FLORIDA MEDICAL ASSOCIATES LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-01 | 275 18th Street, Suite 102, Vero Beach, FL 32960 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| Foreign Limited | 2023-05-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
