| Entity Name: | BROWARD PALM MEDICAL CENTER 1, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Nov 2013 (11 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 25 Oct 2024 (3 months ago) |
| Document Number: | L13000160207 |
| FEI/EIN Number | 35-2507442 |
| Address: | 6849 Taft Street, Hollywood, FL 33024 |
| Mail Address: | 2600 Douglas Rd, Suite 308, CORAL GABLES, FL 33134 |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992117600 | 2014-05-29 | 2014-05-29 | 6849 TAFT ST, HOLLYWOOD, FL, 330245601, US | 6849 TAFT STREET, HOLLYWOOD, FL, 33024, US | |||||||||||||||||
|
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| Phone | +1 305-913-7300 |
| Fax | 3053624776 |
| Phone | +1 303-913-7300 |
Authorized person
| Name | MR. SANTIAGO MOISES |
| Role | DIRECTOR OF CENTERS OPERATIONS |
| Phone | 7863624173 |
Taxonomy
| Taxonomy Code | 302F00000X - Exclusive Provider Organization |
| Is Primary | Yes |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CHOUDHRY, FOWAD | Chief Executive Officer | 6849 TAFT STREET, HOLLYWOOD, FL 33024 |
| Name | Role | Address |
|---|---|---|
| CASILLAS, PATRICIO | Chief Operating Officer | 6849 Taft Street, Hollywood, FL 33024 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Vice President | 6849 TAFT STREET, HOLLYWOOD, FL 33024 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Founder | 6849 TAFT STREET, HOLLYWOOD, FL 33024 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Executive Producer | 6849 TAFT STREET, HOLLYWOOD, FL 33024 |
| Name | Role | Address |
|---|---|---|
| LEAL, JUAN | Administrator | 6849 TAFT STREET, HOLLYWOOD, FL 33024 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000022111 | PALM MEDICAL CENTER HOLLYWOOD | EXPIRED | 2017-03-01 | 2022-12-31 | No data | 2600 DOUGLAS ROAD, SUITE PH-7, CORAL GABLES, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-10-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-25 | 801 US HIGHWAY 1, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2018-01-23 | 6849 Taft Street, Hollywood, FL 33024 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-22 | 6849 Taft Street, Hollywood, FL 33024 | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-10-25 |
| ANNUAL REPORT | 2024-04-04 |
| AMENDED ANNUAL REPORT | 2023-10-16 |
| ANNUAL REPORT | 2023-01-19 |
| AMENDED ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-23 |
Date of last update: 22 Jan 2025
Sources: Florida Department of State
