| Entity Name: | WELLITI, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 11 Aug 2021 (4 years ago) |
| Document Number: | P21000072165 |
| FEI/EIN Number | 87-2110538 |
| Address: | 2814 W. Dr. Martin Luther King Jr Blvd, STE 100, TAMPA, FL, 33607, US |
| Mail Address: | 2814 W. Dr. Martin Luther King Jr Blvd, STE 100, TAMPA, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528733656 | 2021-08-11 | 2022-02-25 | 12114 RUSTIC RIVER WAY, TAMPA, FL, 336359534, US | 2814 W DR MARTIN LUTHER KING JR BLVD STE 100, TAMPA, FL, 336076374, US | |||||||||||||||||||||||
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| Phone | +1 813-534-0009 |
Authorized person
| Name | ERICA HAND |
| Role | CEO |
| Phone | 8134076074 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 109361900 |
| State | FL |
| Issuer | MEDICARE |
| Number | OD330 |
| Name | Role | Address |
|---|---|---|
| HAND ERICA N | Agent | 2814 W Dr Martin Luther King Jr Blvd, Tampa, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| Hand Omari | Vice President | 2814 W Dr Martin Luther King Jr Blvd, Tampa, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| Hand Erica | President | 2814 W. Dr. Martin Luther King Jr. Blvd, Tampa, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-02-22 | 2814 W. Dr. Martin Luther King Jr Blvd, STE 100, TAMPA, FL 33607 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-22 | 2814 W Dr Martin Luther King Jr Blvd, Tampa, FL 33607 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-08 | 2814 W. Dr. Martin Luther King Jr Blvd, STE 100, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-22 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-04-08 |
| Domestic Profit | 2021-08-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
