| Entity Name: | SOUTHEAST WOUNDCARE EXPERTS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 04 Nov 2014 (10 years ago) |
| Date of dissolution: | 19 Jan 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 19 Jan 2017 (8 years ago) |
| Document Number: | L14000171552 |
| FEI/EIN Number | 472258792 |
| Address: | 13520 SW 152 STREET, #771834, MIAMI, FL, 33177, US |
| Mail Address: | 13520 SW 152 STREET, #771834, MIAMI, FL, 33177, US |
| ZIP code: | 33177 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992101471 | 2014-11-11 | 2016-03-23 | 13520 SW 152ND ST, NUMBER 771834, MIAMI, FL, 331770194, US | 13520 SW 152ND ST, NUMBER 771834, MIAMI, FL, 331770101, US | |||||||||||||||||||||||||
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| Phone | +1 305-238-3990 |
| Fax | 3052546331 |
Authorized person
| Name | DR. WILLIAM DAVID LUCKY SR. |
| Role | OWNER |
| Phone | 3052383990 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME29049 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 038136500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BENEBY JANICE F | Agent | 13763 SW 145 TER, MIAMI, FL, 33186 |
| Name | Role | Address |
|---|---|---|
| LUCKY WILLIAM DSR | Owner | 10430 SW 162 TER, MIAMI, FL, 33157 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2017-01-19 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-01 |
| Florida Limited Liability | 2014-11-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
