| Entity Name: | EMBRACING LIFE WELLNESS CENTER. PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Aug 2009 (16 years ago) |
| Last Event: | NAME CHANGE AMENDMENT |
| Event Date Filed: | 31 May 2016 (9 years ago) |
| Document Number: | P09000067389 |
| FEI/EIN Number | 800544347 |
| Address: | 6332 US Hwy 301 South, Riverview, FL, 33578, US |
| Mail Address: | 6332 US Hwy 301 South, Riverview, FL, 33578, US |
| ZIP code: | 33578 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083063176 | 2016-06-09 | 2016-06-09 | 6332 US HIGHWAY 301 S, RIVERVIEW, FL, 335783829, US | 6332 US HIGHWAY 301 S, RIVERVIEW, FL, 335783829, US | |||||||||||||||||||
|
|||||||||||||||||||||||
| Phone | +1 813-662-5919 |
| Fax | 8136718374 |
Authorized person
| Name | DR. MELISSA DAWN FICKEY |
| Role | CEO |
| Phone | 8136625919 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME96297 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| EMBRACING LIFE WELLNESS CENTER, PA 401(K) PLAN | 2022 | 800544347 | 2023-10-16 | EMBRACING LIFE WELLNESS CENTER, PA | 12 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2023-10-16 |
| Name of individual signing | MELISSA FICKEY |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 8133050411 |
| Plan sponsor’s address | 6332 US HIGHWAY 301 S, RIVERVIEW, FL, 335783829 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-14 |
| Name of individual signing | MELISSA FICKEY |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| FICKEY MELISSA DMD | Agent | 6332 US Hwy 301 South, Riverview, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| FICKEY MELISSA DMD | President | 6332 US Hwy 301 South, Riverview, FL, 33578 |
| Name | Role | Address |
|---|---|---|
| FICKEY MELISSA DMD | Director | 6332 US Hwy 301 South, Riverview, FL, 33578 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000114419 | EMBRACING LIFE WELLNESS CENTER | ACTIVE | 2015-11-10 | 2025-12-31 | No data | 6332 US HWY 301 S, RIVERVIEW, FL, 33578 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-01-09 | 6332 US Hwy 301 South, Riverview, FL 33578 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-09 | 6332 US Hwy 301 South, Riverview, FL 33578 | No data |
| CHANGE OF MAILING ADDRESS | 2017-01-09 | 6332 US Hwy 301 South, Riverview, FL 33578 | No data |
| NAME CHANGE AMENDMENT | 2016-05-31 | EMBRACING LIFE WELLNESS CENTER. PA | No data |
| REGISTERED AGENT NAME CHANGED | 2016-05-24 | FICKEY, MELISSA DAWN, MD | No data |
| REINSTATEMENT | 2014-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2011-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000629534 | TERMINATED | 1000000619848 | HILLSBOROU | 2014-04-28 | 2024-05-09 | $ 702.52 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 6302 E DR MARTIN LUTHER KING JR BLVD S, TAMPA FL336191166 |
| J13000988197 | TERMINATED | 1000000511286 | HILLSBOROU | 2013-05-09 | 2023-05-22 | $ 787.49 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 6302 E DR MARTIN LUTHER KING JR BLVD S, TAMPA FL336191166 |
| J12000880180 | TERMINATED | 1000000365113 | HILLSBOROU | 2012-11-19 | 2022-11-28 | $ 588.12 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 6302 E DR MARTIN LUTHER KING JR BLVD S, TAMPA FL336191166 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-07-13 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-01-09 |
| Name Change | 2016-05-31 |
| ANNUAL REPORT | 2016-05-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
