| Entity Name: | ELITE WELLNESS INTERNAL MEDICINE INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Apr 2023 (2 years ago) |
| Document Number: | P23000030608 |
| FEI/EIN Number | 92-3825171 |
| Address: | 1615 S CONGRESS AVE, SUITE 103, DELRAY BEACH, FL, 33445, US |
| Mail Address: | 6615 W BOYNTON BEACH BLVD, SUITE 412, BOYNTON BEACH, FL, 33437, US |
| ZIP code: | 33445 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114783479 | 2024-02-26 | 2024-04-07 | 6615 W BOYNTON BEACH BLVD STE 412, BOYNTON BEACH, FL, 334373526, US | 2300 S CONGRESS AVE STE 105, BOYNTON BEACH, FL, 334267400, US | |||||||||||||||
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| Phone | +1 561-203-5282 |
| Fax | 7402128513 |
Authorized person
| Name | KANDY MORRIS |
| Role | SVP OF MANAGED CARE |
| Phone | 7027280528 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GALLO-THYS TERESA | Agent | 6615 W BOYNTON BEACH BLVD, BOYNTON, FL, 33437 |
| Name | Role | Address |
|---|---|---|
| GALLO-THYS TERESA | President | 6615 W BOYNTON BEACH BLVD, STE 412, BOYNTON BEACH, FL, 33437 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-25 |
| Domestic Profit | 2023-04-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
