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DeSoto Wellness Clinic, LLC

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Company Details

Name: DeSoto Wellness Clinic, LLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 23 Aug 2021 (4 years ago)
Business ID: 1300000
ZIP code: 38901
County: Grenada
State of Incorporation: MISSISSIPPI
Principal Office Address: 222 Southlakes DriveGrenada, MS 38901

Agent

Name Role Address
K Brooke Shoultz Agent 365 Lakeview Blvd., Biloxi, MS 39531

Organizer

Name Role Address
K Brooke Shoultz Organizer 365 Lakeview Blvd., Biloxi, MS 39531

Manager

Name Role Address
Rosemarie Jaggai Manager 222 Southlakes Drive, Grenada, MS 38901

National Provider Identifier

NPI Number:
1750051173
Certification Date:
2021-09-16

Authorized Person:

Name:
DR. CEDRIC EDWARDS
Role:
MEDICAL DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
1041C0700X - Clinical Social Worker
Is Primary:
No
Selected Taxonomy:
101YA0400X - Addiction (Substance Use Disorder) Counselor
Is Primary:
Yes

Contacts:

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-02-17 Annual Report For DeSoto Wellness Clinic, LLC
Annual Report LLC Filed 2024-05-29 Annual Report For DeSoto Wellness Clinic, LLC
Annual Report LLC Filed 2023-06-13 Annual Report For DeSoto Wellness Clinic, LLC
Annual Report LLC Filed 2022-04-13 Annual Report For DeSoto Wellness Clinic, LLC
Formation Form Filed 2021-08-23 Formation For DeSoto Wellness Clinic, LLC

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Date of last update: 27 May 2025

Sources: Company Profile on Mississippi Secretary of State Website