| Entity Name: | PRIMARY CARE AND EDUCATIONAL CENTER OF MIAMI, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Aug 2015 (9 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 13 Nov 2015 (9 years ago) |
| Document Number: | L15000142308 |
| FEI/EIN Number | 47-4964427 |
| Mail Address: | 13205 SW 137 AVE, MIAMI, FL, 33186, US |
| Address: | 13205 SW 137AVE, MIAMI, FL, 33186, US |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1174995609 | 2015-10-23 | 2024-04-30 | 13205 SW 137TH AVE # 224-225, MIAMI, FL, 331865331, US | 13205 SW 137TH AVE STE 232-233, MIAMI, FL, 331865331, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 786-290-9192 |
| Fax | 7866038893 |
| Fax | 8006038893 |
Authorized person
| Name | EDDY MARCIAL |
| Role | PRESIDENT |
| Phone | 7862909192 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | ARNP9231287 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ARNP9231287 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI (PERSONAL) |
| Number | 1841694221 |
| State | FL |
| Issuer | MEDICAID |
| Number | 016803600 |
| State | FL |
| Issuer | NPI |
| Number | 1174995609 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARCIAL EDDY | Agent | 13205 SW 137 AVE, MIAMI, FL, 33186 |
| Name | Role | Address |
|---|---|---|
| MARCIAL EDDY | Manager | 13205 SW 137 AVE, MIAMI, FL, 33186 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-03-22 | 13205 SW 137AVE, SUITE 224-225, MIAMI, FL 33186 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-27 | 13205 SW 137AVE, SUITE 224-225, MIAMI, FL 33186 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-27 | 13205 SW 137 AVE, 224-225, MIAMI, FL 33186 | No data |
| LC AMENDMENT | 2015-11-13 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-20 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-22 |
| ANNUAL REPORT | 2022-03-27 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-03-22 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-03-16 |
| ANNUAL REPORT | 2016-03-21 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
