| Entity Name: | Westport Medical and Wellness Center, PLLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Dissolved |
| Date Formed: | 19 Oct 2021 |
| Date of dissolution: | 23 Jan 2023 |
| Business ALEI: | 2365874 |
| NAICS code: | 621111 - Offices of Physicians (except Mental Health Specialists) |
| Business address: | 4 Whitney Extension, Westport, CT, 06880, United States |
| Mailing address: | 4 Whitney Extension, Westport, CT, United States, 06880 |
| ZIP code: | 06880 |
| County: | Fairfield |
| Place of Formation: | CONNECTICUT |
| E-Mail: | cngorman1@yahoo.com |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WESTPORT MEDICAL AND WELLNESS CENTER PLLC | 2022 | 873223669 | 2023-07-31 | WESTPORT MEDICAL AND WELLNESS CENTER PLLC | 1 | |||||||||||||||||||||||||||||||
|
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| Administrator’s EIN | 842925395 |
| Plan administrator’s name | 401GO, INC. |
| Plan administrator’s address | 8427 OLD BINGHAM HWY, WEST JORDAN, UT, 84088 |
| Administrator’s telephone number | 8012142125 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-31 |
| Name of individual signing | FIDUCIARY ASSISTANCE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Mailing address | Phone | Residence address | |
|---|---|---|---|---|---|---|
| Carol Nicole Gorman, M.D. | Agent | 4 Whitney Extension, Westport, CT, 06880, United States | 4 Whitney Extension, Westport, CT, 06880, United States | +1 203-216-5577 | cngorman1@yahoo.com | 3 Caccamo Lane, Westport, CT, 06880, United States |
| Name | Role | Business address | Phone | Residence address | |
|---|---|---|---|---|---|
| Carol Nicole Gorman, M.D. | Officer | 4 Whitney Extension, Westport, CT, 06880, United States | +1 203-216-5577 | cngorman1@yahoo.com | 3 Caccamo Lane, Westport, CT, 06880, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0011675584 | 2023-01-23 | 2023-01-23 | Dissolution | Certificate of Dissolution | No data |
| BF-0010376857 | 2022-03-26 | No data | Annual Report | Annual Report | 2022 |
| BF-0010132299 | 2021-10-19 | No data | Business Formation | Certificate of Organization | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
