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  5. MIAMI BEACH COMMUNITY HEALTH CENTER INC.

MIAMI BEACH COMMUNITY HEALTH CENTER INC.

Company Details

Entity Name: MIAMI BEACH COMMUNITY HEALTH CENTER INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 01 Mar 1977 (48 years ago)
Document Number: 738164
FEI/EIN Number 591829984
Address: 11645 BISCAYNE BLVD, 207, MIAMI, FL, 33181, US
Mail Address: 11645 BISCAYNE BLVD, 207, MIAMI, FL, 33181, US
ZIP code: 33181
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1821667981 2021-06-23 2024-08-28 11645 BISCAYNE BLVD STE 207, NORTH MIAMI, FL, 331813138, US 11645 BISCAYNE BLVD STE 100, NORTH MIAMI, FL, 331813155, US

Contacts
Phone +1 305-538-8835
Fax 3059384044

Authorized person
Name LIZEL VIONET GONZALEZ
Role SENIOR EVP OF HUMAN RESOURCES
Phone 3052834749

Taxonomy
Taxonomy Code 208D00000X - General Practice Physician
Is Primary No
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 029544230
State FL
Issuer MEDICAID
Number 029544231
State FL

Legal Entity Identifier

LEI number Registered As Jurisdiction Of Formation General Category Entity Status Entity created at
2549007TCSPQMUEFUL13 738164 US-FL GENERAL ACTIVE 1977-03-01

Addresses
Legal C/O Dillon, William P, 215 S Monroe St Ste 601, Tallahassee, US-FL, US, 32301
Headquarters 11645 Biscayne Blvd, Suite 207, Miami, US-FL, US, 33181

Registration details
Registration Date 2022-06-16
Last Update 2024-05-20
Status ISSUED
Next Renewal 2025-06-16
LEI Issuer 5493001KJTIIGC8Y1R12
Corroboration Level FULLY_CORROBORATED
Data Validated As 738164

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2016 591829984 2018-03-14 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 391
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 407
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2018-03-14
Name of individual signing MARK DELVAUX
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2015 591829984 2017-03-20 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 308
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 391
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2017-03-20
Name of individual signing MARK DELVAUX
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2014 591829984 2016-03-17 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 282
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 308
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2016-03-17
Name of individual signing MARK DELVAUX
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2013 591829984 2014-12-23 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 282
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 261

Signature of
Role Plan administrator
Date 2014-12-23
Name of individual signing MARK DELVAUX
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2013 591829984 2014-12-23 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 380
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 282

Signature of
Role Plan administrator
Date 2014-12-23
Name of individual signing MARK DELVAUX
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 2012 591829984 2013-12-26 MIAMI BEACH COMMUNITY HEALTH CENTER, INC. 363
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2012-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Number of participants as of the end of the plan year
Active participants 380

Signature of
Role Plan administrator
Date 2013-12-26
Name of individual signing BRIAN MORTON
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER 2011 591829984 2013-06-14 MIAMI BEACH COMMUNITY HEALTH CENTER 363
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2011-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s DBA name SAME
Plan sponsor’s mailing address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181

Plan administrator’s name and address
Administrator’s EIN 591829984
Plan administrator’s name MIAMI BEACH COMMUNITY HEALTH CENTER
Plan administrator’s address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181
Administrator’s telephone number 3055388835

Number of participants as of the end of the plan year
Active participants 363

Signature of
Role Plan administrator
Date 2013-06-14
Name of individual signing BRIAN MORTON
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER 2011 591829984 2013-03-08 MIAMI BEACH COMMUNITY HEALTH CENTER 363
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2011-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s DBA name SAME
Plan sponsor’s mailing address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181

Plan administrator’s name and address
Administrator’s EIN 591829984
Plan administrator’s name MIAMI BEACH COMMUNITY HEALTH CENTER
Plan administrator’s address 11645 BISCAYNE BLVD, SUITE 207, MIAMI, FL, 33181
Administrator’s telephone number 3055388835

Number of participants as of the end of the plan year
Active participants 363

Signature of
Role Plan administrator
Date 2013-03-08
Name of individual signing BRIAN MORTON
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER 2010 591829984 2013-06-14 MIAMI BEACH COMMUNITY HEALTH CENTER 22
File View Page
Three-digit plan number (PN) 501
Effective date of plan 2010-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s DBA name SAME
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Plan administrator’s name and address
Administrator’s EIN 591829984
Plan administrator’s name MIAMI BEACH COMMUNITY HEALTH CENTER
Plan administrator’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Administrator’s telephone number 3055388835

Number of participants as of the end of the plan year
Active participants 22

Signature of
Role Plan administrator
Date 2013-06-14
Name of individual signing BRIAN MORTON
Valid signature Filed with authorized/valid electronic signature
MIAMI BEACH COMMUNITY HEALTH CENTER 2010 591829984 2013-03-08 MIAMI BEACH COMMUNITY HEALTH CENTER No data
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2010-06-01
Business code 813000
Sponsor’s telephone number 3055388835
Plan sponsor’s DBA name SAME
Plan sponsor’s mailing address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Plan sponsor’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181

Plan administrator’s name and address
Administrator’s EIN 591829984
Plan administrator’s name MIAMI BEACH COMMUNITY HEALTH CENTER
Plan administrator’s address 11645 BISCAYNE BLVD., SUITE 207, MIAMI, FL, 33181
Administrator’s telephone number 3055388835

Signature of
Role Plan administrator
Date 2013-03-08
Name of individual signing BRIAN MORTON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DILLON WILLIAM P Agent 215 S MONROE ST STE 601, TALLAHASSEE, FL, 32301

Director

Name Role Address
Massey David Esq. Director 200 Biscayne Blvd. Way, #307, Miami, FL, 33131
Lambert Barbara Director 3870 Amalfi Drive, Hollywood, FL, 33021
Chamberlain David Director 8220 SW 160th Street, Palmetto Bay, FL, 33157
Gibb Therese Director 8866 Hawthorne Avenue, Surfside, FL, 33154
Rubinson Mitchell Director 6109 Laguna Drive West, Miami Beach, FL, 33141
Gersten David M Director 9102 W Bay Harbor Drive, Bay Harbor Islands, FL, 33154

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000032772 MIAMI BEACH COMMUNITY HEALTH CENTER CLINICAL CAMPUS EXPIRED 2012-04-05 2017-12-31 No data 11645 BISCAYNE BOULEVARD,SUITE 207, MIAMI, FL, 33181
G09000113770 COOP EXPIRED 2009-06-04 2014-12-31 No data MIAMI BEACH COMMUNITY HEALTH CENTER, 710 ALTON ROAD, MIAMI BEACH, FL, 33139

Events

Event Type Filed Date Value Description
AMENDMENT 2012-08-10 No data No data
NAME CHANGE AMENDMENT 2001-10-10 MIAMI BEACH COMMUNITY HEALTH CENTER INC. No data
NAME CHANGE AMENDMENT 1981-07-02 STANLEY C. MYERS COMMUNITY HEALTH CENTER, INC. No data

Related by officers

Chamberlain David

SUNFLOWER MARGATE ASSOCIATION, INC.

DILLON WILLIAM P

INTEGRAL HEALTH PLAN, LLC FLORIDA ELECTRONIC HEALTH CENTERS NETWORK, INC. WILLIAM P. DILLON, P.A.

Related by address

No related companies by address

Date of last update: 02 Feb 2025

Sources: Florida Department of State

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