| Entity Name: | CORRADO, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Jun 2009 (16 years ago) |
| Document Number: | L09000061005 |
| FEI/EIN Number | 270419339 |
| Address: | 423 Nikomas Way, Melbourne Beach, FL, 32951-3529, US |
| Mail Address: | 3830 S Hwy A1A Suite 4 PMB 139, Melbourne BEACH, FL, 32951-3529, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1245518976 | 2011-07-29 | 2019-03-11 | 1698 B WEST HIBISCUS BLVD, SUITE B, MELBOURNE, FL, 329012639, US | 1698 B WEST HIBISCUS BLVD, SUITE B, MELBOURNE, FL, 329012639, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-917-2042 |
| Fax | 3345601469 |
Authorized person
| Name | CECILIA MARIE CORRADO |
| Role | MGR |
| Phone | 3216155560 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | Yes |
| Taxonomy Code | 363LC0200X - Critical Care Medicine Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 363LP2300X - Primary Care Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 307023900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CORRADO CECILIA M | Agent | 423 Nikomas Way, MELBOURNE BEACH, FL, 32951 |
| Name | Role | Address |
|---|---|---|
| Corrado Cecilia M | Manager | 423 Nikomas Way, MELBOURNE BEACH, FL, 32951 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000020289 | OSPREY BEHAVIORAL HEALTH | EXPIRED | 2013-02-27 | 2018-12-31 | No data | P.O.BOX 33864, INDIALANTIC, FL, 32903 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-01-27 | 423 Nikomas Way, Melbourne Beach, FL 32951-3529 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-27 | 423 Nikomas Way, MELBOURNE BEACH, FL 32951 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-10-05 | 423 Nikomas Way, Melbourne Beach, FL 32951-3529 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-05-24 |
| ANNUAL REPORT | 2019-06-14 |
| ANNUAL REPORT | 2018-01-21 |
| ANNUAL REPORT | 2017-03-04 |
| ANNUAL REPORT | 2016-03-24 |
| ANNUAL REPORT | 2015-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
