| Entity Name: | METAVIDA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Mar 2024 (a year ago) |
| Document Number: | M24000003397 |
| Address: | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| Mail Address: | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982450540 | 2024-04-25 | 2024-04-25 | 701 OLD DIXIE HWY, TEQUESTA, FL, 334692493, US | 701 OLD DIXIE HWY, TEQUESTA, FL, 334692493, US | |||||||||||||||||||||
|
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| Phone | +1 561-523-8887 |
Authorized person
| Name | DR. TAMMY MALLOY |
| Role | CHIEF OPERATING OFFICER |
| Phone | 5613769790 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | No |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| HOLLOWAY, GARY M, SR. | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| DIGIUSEPPE, ROBERT | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| SACUNAS, ABBY | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| HOLLOWAY, MICHAEL | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| MALLOY, TAMMY | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| TAITELMAN, ANDREW | Authorized Person | 10 CAMPUS BLVD., NEWTOWN SQUARE, PA 19073 |
| Name | Date |
|---|---|
| Foreign Limited | 2024-03-15 |
Date of last update: 07 Jan 2025
Sources: Florida Department of State
