| Entity Name: | 904 HEALTH, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 08 Apr 2022 (3 years ago) |
| Document Number: | N22000004004 |
| FEI/EIN Number | 88-2746803 |
| Address: | 221 N. HOGAN, SUITE 118, JACKSONVILLE, FL, 32202, US |
| Mail Address: | 221 N. HOGAN STREET, SUITE 118, JACKSONVILLE, FL, 32202, US |
| ZIP code: | 32202 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184305435 | 2023-07-28 | 2023-07-28 | 221 N HOGAN ST STE 118, JACKSONVILLE, FL, 322024201, US | 4427 EMERSON ST STE A, JACKSONVILLE, FL, 322074969, US | |||||||||||||||||||||||||||||
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| Phone | +1 904-659-2475 |
Authorized person
| Name | JAMES TARVER |
| Role | DIRECTOR |
| Phone | 9044032079 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
| Taxonomy Code | 251K00000X - Public Health or Welfare Agency |
| Is Primary | No |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| TARVER JAMES | Agent | 221 N. HOGAN STREET, JACKSONVILLE, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| TARVER JAMES | Director | 221 N. HOGAN STREET, SUITE 118, JACKSONVILLE, FL, 32202 |
| CANNON LYDIA | Director | 221 N. HOGAN STREET, SUITE 118, JACKSONVILLE, FL, 32202 |
| VIDAL NANA STONE | Director | 221 N. HOGAN STREET, SUITE 118, JACKSONVILLE, FL, 32202 |
| RASCOE VALMA | Director | 221 N Hogan St, Suite 118, JACKSONVILLE, FL, 32202 |
| Name | Role | Address |
|---|---|---|
| McKAGUE MELISSA | Admi | 221 N. HOGAN STREET, JACKSONVILLE, FL, 32202 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-27 |
| Domestic Non-Profit | 2022-04-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
