| Entity Name: | Revive Telehealth, LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Foreign |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 20 Feb 2023 |
| Business ALEI: | 2727507 |
| Annual report due: | 31 Mar 2025 |
| NAICS code: | 621112 - Offices of Physicians, Mental Health Specialists |
| Business address: | 81 Roanoke Avenue, Fairfield, CT, 06824, United States |
| Mailing address: | 81 Roanoke Avenue, Fairfield, CT, United States, 06824 |
| Mailing jurisdiction address: | 1010 W Foxwood Dr, Raymore, MO, 64083-9196, United States |
| ZIP code: | 06824 |
| County: | Fairfield |
| Place of Formation: | MISSOURI |
| E-Mail: | kmorgan@collinsjones.com |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| REVIVE TELEHEALTH 401(K) PLAN | 2023 | 853702997 | 2024-07-22 | REVIVE TELEHEALTH | 0 | |||||||||||||||||||||||
|
||||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-07-22 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Mailing address | Phone | Residence address | |
|---|---|---|---|---|---|---|
| Omar Ziyadeh | Agent | 81 Roanoke Ave, Fairfield, CT, 06824-6124, United States | 81 Roanoke Ave, Fairfield, CT, 06824-6124, United States | +1 203-430-1321 | omar@revivetelehealth.com | 81 Roanoke Ave, Fairfield, CT, 06824-6124, United States |
| Name | Role | Business address | Phone | Residence address | |
|---|---|---|---|---|---|
| Omar Ziyadeh | Officer | 81 Roanoke Ave, Fairfield, CT, 06824-6124, United States | +1 203-430-1321 | omar@revivetelehealth.com | 81 Roanoke Ave, Fairfield, CT, 06824-6124, United States |
| Aneel Ursani | Officer | No data | No data | No data | 8029 W 166th Pl, Overland Park, KS, 66085-8237, United States |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012402847 | 2024-01-24 | No data | Annual Report | Annual Report | No data |
| BF-0011705814 | 2023-02-20 | No data | Business Registration | Foreign Registration Statement | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
