| Entity Name: | BIRD GALLOWAY HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Mar 2011 (14 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 04 Aug 2011 (13 years ago) |
| Document Number: | L11000027052 |
| FEI/EIN Number | 45-2489480 |
| Address: | 7035 SW 87TH AVE., MIAMI, FL 33173 |
| Mail Address: | 20900 NE 30TH AVE - STE 303, AVENTURA, FL 33180 |
| ZIP code: | 33173 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689951808 | 2011-11-16 | 2020-01-31 | 20900 NE 30TH AVE STE 303, AVENTURA, FL, 331802162, US | 7035 SW 87TH AVE, MIAMI, FL, 331732505, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 305-370-3540 |
| Fax | 3059351729 |
| Phone | +1 786-422-8302 |
| Fax | 7864567135 |
Authorized person
| Name | ARI LEVY |
| Role | EXECUTIVE GENERAL MANAGER |
| Phone | 7864227313 |
Taxonomy
| Taxonomy Code | 333600000X - Pharmacy |
| Is Primary | No |
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| License Number | PH25837 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008003200 |
| State | FL |
| Issuer | PK |
| Number | 2133140 |
| Name | Role |
|---|---|
| IFO REGISTERED AGENTS, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| LEVY, ARI | Manager | 20900 NE 30TH AVE - STE 303, AVENTURA, FL 33180 |
| PRIETO ESPUNY, LADISLAO M | Manager | 117 NW 42ND AVENUE, APT 1400, MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| RUAH, STANLEY D | Managing Member | 20900 NE 30TH AVE - STE 303, AVENTURA, FL 33180 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000058110 | LOCATEL HEALTH & WELLNESS | ACTIVE | 2012-06-13 | 2027-12-31 | No data | 7035 SW 87TH AVE, MIAMI, FL, 33173 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-17 | 7035 SW 87TH AVE., MIAMI, FL 33173 | No data |
| CHANGE OF MAILING ADDRESS | 2013-01-22 | 7035 SW 87TH AVE., MIAMI, FL 33173 | No data |
| LC AMENDMENT | 2011-08-04 | No data | No data |
| LC AMENDMENT | 2011-05-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-01-16 |
| ANNUAL REPORT | 2016-01-28 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
