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Pediatric Haven, LLC

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Company Details

Name: Pediatric Haven, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 15 Apr 2020 (5 years ago)
Business ID: 1207323
ZIP code: 39046
County: Madison
State of Incorporation: MISSISSIPPI
Principal Office Address: 112 Westfalen DriveCanton, MS 39046

Agent

Name Role Address
Jetuwan Brown Agent 103 Honours Drive, Madison, MS 39110

Manager

Name Role Address
Jetuwan M Brown Manager 103 Honours Drive, Madison, MS 39110

National Provider Identifier

NPI Number:
1043858053
Certification Date:
2024-01-04

Authorized Person:

Name:
MRS. JETUWAN M. BROWN
Role:
MANAGING PARTNER
Phone:

Taxonomy:

Selected Taxonomy:
261QM3000X - Medically Fragile Infants and Children Day Care
Is Primary:
No
Selected Taxonomy:
3140N1450X - Pediatric Skilled Nursing Facility
Is Primary:
No
Selected Taxonomy:
103K00000X - Behavior Analyst
Is Primary:
No
Selected Taxonomy:
261QD1600X - Developmental Disabilities Clinic/Center
Is Primary:
No
Selected Taxonomy:
261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center)
Is Primary:
No

Contacts:

Fax:
6014996696

Form 5500 Series

Employer Identification Number (EIN):
844027209
Plan Year:
2023
Number Of Participants:
0
Sponsors Telephone Number:

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2024-11-10 Annual Report For Pediatric Haven, LLC
Notice to Dissolve/Revoke Filed 2024-09-01 Notice of Intent to Dissolve: AR: Pediatric Haven, LLC
Annual Report LLC Filed 2023-04-25 Annual Report For Pediatric Haven, LLC
Amendment Form Filed 2023-02-07 Amendment For Pediatric Haven, LLC
Annual Report LLC Filed 2023-02-07 Annual Report For Pediatric Haven, LLC
Reinstatement Filed 2022-03-02 Reinstatement For Pediatric Haven, LLC
Admin Dissolution Filed 2021-11-29 Action of Intent to Dissolve: AR: Pediatric Haven, LLC
Notice to Dissolve/Revoke Filed 2021-09-07 Notice of Intent to Dissolve: AR: Pediatric Haven, LLC
Formation Form Filed 2020-04-15 Formation For Pediatric Haven, LLC

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Date of last update: 22 May 2025

Sources: Company Profile on Mississippi Secretary of State Website