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PHOENIX HEALTH ASCENDENCY LLC - Florida Company Profile

Company Details

Entity Name: PHOENIX HEALTH ASCENDENCY LLC
Jurisdiction: FLORIDA
Filing Type: Foreign Limited Liability Co.
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 22 May 2023 (2 years ago)
Document Number: M23000007144
FEI/EIN Number 923648109

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 17011 STATE RD 50 STE 103, CLERMONT, FL, 34711
Mail Address: 17011 STATE RD 50 STE 103, CLERMONT, FL, 34711
ZIP code: 34711
County: Lake
Place of Formation: WYOMING

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1336837665 2023-04-25 2023-05-05 17011 STATE ROAD 50 STE 103, CLERMONT, FL, 347118203, US 17011 STATE ROAD 50 STE 103, CLERMONT, FL, 347118203, US

Contacts

Phone +1 323-695-3822

Authorized person

Name HEATHER DIAZ
Role ADMINISTRATOR
Phone 3236953822

Taxonomy

Taxonomy Code 207KA0200X - Allergy Physician
Is Primary No
Taxonomy Code 207Q00000X - Family Medicine Physician
Is Primary Yes
Taxonomy Code 208000000X - Pediatrics Physician
Is Primary No
Taxonomy Code 2080A0000X - Pediatric Adolescent Medicine Physician
Is Primary No
Taxonomy Code 208D00000X - General Practice Physician
Is Primary No

Other Provider Identifiers

Issuer MEDICAID
Number 277908100
State FL

Key Officers & Management

Name Role Address
Smith Matt Owne 17011 STATE RD 50 STE 103, CLERMONT, FL, 34711
SEPE AL Agent 1801 NE 123 ST STE 314, N MIAMI, FL, 33181

Documents

Name Date
ANNUAL REPORT 2024-02-21
Foreign Limited 2023-05-22

Date of last update: 02 Mar 2025

Sources: Florida Department of State