| Entity Name: | INNOVATIVE CARE II, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 06 Apr 2009 (16 years ago) |
| Document Number: | L09000033307 |
| FEI/EIN Number | 26-4638469 |
| Address: | 12600 PEMBROKE RD, SUITE 100, MIRAMAR, FL 33027 |
| Mail Address: | 1 SW 129th Ave, STE 304, PEMBROK PINES, FL 33027 |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790086023 | 2010-11-03 | 2022-07-21 | 1 SW 129TH AVE STE 304, PEMBROKE PINES, FL, 330271717, US | 12600 PEMBROKE RD, SUITE 100, MIRAMAR, FL, 330272544, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-843-7230 |
| Fax | 8776714101 |
Authorized person
| Name | GOKHAN GUVENLI |
| Role | MEDICAL DIRECTOR |
| Phone | 9544509595 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS10374 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE |
| Number | BW654Z |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | FJ749A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Farideh, GOZLEVELI, Phd | Agent | 2847 NE 26TH PLACE, FT LAUDERDALE, FL 33306 |
| Name | Role | Address |
|---|---|---|
| GOZLEVELI, Farideh V, Phd | Chief Executive Officer | 1 SW 129th Ave, STE 304 PEMBROK PINES, FL 33027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000027171 | PRIMARY CARE OFFICES | ACTIVE | 2011-03-16 | 2026-12-31 | No data | 1 S.W. 129TH. AVE., SUITE #304, PEMBROKE PINES, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2015-02-16 | Farideh, GOZLEVELI, Phd | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-03-04 | 12600 PEMBROKE RD, SUITE 100, MIRAMAR, FL 33027 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-27 | 12600 PEMBROKE RD, SUITE 100, MIRAMAR, FL 33027 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-03-26 | 2847 NE 26TH PLACE, FT LAUDERDALE, FL 33306 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-12 |
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-02-23 |
| ANNUAL REPORT | 2022-02-15 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-03-11 |
| ANNUAL REPORT | 2016-03-03 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3926197100 | 2020-04-12 | 0455 | PPP | 12600 PEMBROKE RD STE 100, HOLLYWOOD, FL, 33027-2543 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 24 Feb 2025
Sources: Florida Department of State
