| Entity Name: | ANGELS THERAPY CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Jan 2014 (11 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | L14000008252 |
| FEI/EIN Number | 46-4538754 |
| Address: | 9270 SW 150 AVE, Suite 301-302, MIAMI, FL, 33196, US |
| Mail Address: | 9260 HAMMOCKS BLVD, 202, MIAMI, FL, 33196, US |
| ZIP code: | 33196 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598187106 | 2014-01-16 | 2014-04-04 | 9260 HAMMOCKS BLVD, SUITE 202, MIAMI, FL, 331961503, US | 9260 HAMMOCKS BLVD, SUITE 202, MIAMI, FL, 331961503, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-383-2091 |
Authorized person
| Name | JOHANNES LOPEZ |
| Role | MEDICAL DIRECTOR |
| Phone | 3053832091 |
Taxonomy
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| License Number | ME78225 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ME 78225 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 252Y00000X - Early Intervention Provider Agency |
| License Number | ME78225 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010442000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARIA NAVARRO | Agent | 9260 HAMMOCKS BLVD, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| LOPEZ JOHANNES MD | Manager | 9260 HAMMOCKS BLVD SUITE 202, MIAMI, FL, 33196 |
| NAVARRO MARIA | Manager | 9260 HAMMOCKS BLVD SUITE 202, MIAMI, FL, 33196 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-21 | 9270 SW 150 AVE, Suite 301-302, MIAMI, FL 33196 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-03-21 | MARIA, NAVARRO | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-03-21 |
| Florida Limited Liability | 2014-01-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
