| Entity Name: | DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 18 Apr 1978 (47 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 09 Sep 2024 (8 months ago) |
| Document Number: | 742508 |
| FEI/EIN Number |
591923396
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1680 MERIDIAN AVENUE, SUITE 501, MIAMI BEACH, FL, 33139, US |
| Mail Address: | 1680 MERIDIAN AVENUE, SUITE 501, MIAMI BEACH, FL, 33139, US |
| ZIP code: | 33139 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1114991544 | 2006-02-14 | 2018-08-15 | 1680 MERIDIAN AVE STE 501, MIAMI BEACH, FL, 331392719, US | 1680 MERIDIAN AVE, SUITE 501, MIAMI BEACH, FL, 33139, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-531-5341 |
| Fax | 3055325322 |
Authorized person
| Name | LARRY J LONG |
| Role | CFO |
| Phone | 3055315341 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | KH909 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| License Number | KH909 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | KH909 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 310500000X - Mental Illness Intermediate Care Facility |
| License Number | KH909 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 060289200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060289203 |
| State | FL |
| Issuer | MEDICAID |
| Number | 090289204 |
| State | FL |
| Issuer | MEDICAID |
| Number | 100730100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060289201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Hernandez Orestes | Secretary | 3434 Sapphire Hollow Way, Ft. Pierce, FL, 34981 |
| Yasbin Eileen REsq. | President | 2710 NE 183rd Street, Aventura, FL, 33160 |
| Bryn Kristina | Vice President | 9120 W. Bay Harbor Drive, Bay Harbor, FL, 33154 |
| Cahill Susan MEsq. | Treasurer | Bryn Law Group., Miami, FL, 33131 |
| VAZQUEZ DE MIGUEL TATIANA | Chief Executive Officer | 1680 MERIDIAN AVENUE, MIAMI BEACH, FL, 33139 |
| VAZQUEZ DE MIGUEL TATIANA CEO | Agent | 1680 MERIDIAN AVENUE, MIAMI BEACH, FL, 33139 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-01-02 | VAZQUEZ DE MIGUEL, TATIANA, CEO | - |
| AMENDMENT | 2024-09-09 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-04 | 1680 MERIDIAN AVENUE, SUITE 501, MIAMI BEACH, FL 33139 | - |
| CHANGE OF MAILING ADDRESS | 2012-01-04 | 1680 MERIDIAN AVENUE, SUITE 501, MIAMI BEACH, FL 33139 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-04 | 1680 MERIDIAN AVENUE, SUITE 501, MIAMI BEACH, FL 33139 | - |
| NAME CHANGE AMENDMENT | 1980-10-21 | DOUGLAS GARDENS COMMUNITY MENTAL HEALTH CENTER OF MIAMI BEACH, INC. | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| Amendment | 2024-09-09 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-09 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-02-11 |
| ANNUAL REPORT | 2019-03-13 |
| ANNUAL REPORT | 2018-01-22 |
| ANNUAL REPORT | 2017-03-20 |
Date of last update: 03 May 2025
Sources: Florida Department of State
