| Entity Name: | BREVARD HEALTH CENTER, PL |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 Apr 2010 (15 years ago) |
| Document Number: | L10000041002 |
| FEI/EIN Number | 27-2435182 |
| Address: | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 |
| Mail Address: | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215254073 | 2010-05-03 | 2024-10-22 | 298 MICHIGAN AVE, SUITE 101, MELBOURNE, FL, 329013104, US | 298 MICHIGAN AVE, SUITE 101, MELBOURNE, FL, 329013104, US | |||||||||||||||||||||||||||
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| Phone | +1 321-215-6899 |
| Fax | 3212156789 |
Authorized person
| Name | APARNA BALAJI |
| Role | OPERATING OFFICER |
| Phone | 3212156899 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAIL ROAD MEDICARE |
| Number | 110199177 |
| State | FL |
| Issuer | MEDICAID |
| Number | 257850600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BALAJI, GOBIVENKATA | Agent | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 |
| Name | Role | Address |
|---|---|---|
| BALAJI, GOBIVENKATA M.D. | Managing Member | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-04-01 | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 | No data |
| CHANGE OF MAILING ADDRESS | 2012-04-01 | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-04-01 | 298 MICHIGAN AVENUE, MELBOURNE, FL 32901 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-06-07 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-03-15 |
Date of last update: 25 Jan 2025
Sources: Florida Department of State
