| Entity Name: | COCONUT GROVE RECOVERY LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Sep 2015 (9 years ago) |
| Date of dissolution: | 11 Mar 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 11 Mar 2020 (5 years ago) |
| Document Number: | L15000159485 |
| FEI/EIN Number | 47-5092288 |
| Address: | 5001 Hollywood Blvd., Hollywood, FL, 33021, US |
| Mail Address: | 5001 Hollywood Blvd., Hollywood, FL, 33021, US |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912456435 | 2016-09-26 | 2016-09-26 | 15291 NW 60TH AVE, STE 200, MIAMI LAKES, FL, 330142458, US | 15291 NW 60TH AVE STE 200, STE 200, MIAMI LAKES, FL, 330142460, US | |||||||||||||||||||||||||
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| Phone | +1 855-366-5224 |
| Fax | 8557684701 |
Authorized person
| Name | CATHY PICILLO |
| Role | BILLING COLLECTION MANAGER |
| Phone | 9549937165 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| License Number | 10D2106134 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CMS CLIA LICENSE |
| Number | 10D2106134 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Barnhart, Esq. Valerie | Agent | 12555 Orange Drive, Second Floor, Davie, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| GIRALDEZ BRIAN | Manager | 5001 Hollywood Blvd., Hollywood, FL, 33021 |
| WARD CHRISTOPHER | Manager | 5001 Hollywood Blvd., Hollywood, FL, 33021 |
| Slatus Shlomo L | Manager | 5001 Hollywood Blvd., Hollywood, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| Bota Marissa | Exec | 5001 Hollywood Blvd., Hollywood, FL, 33021 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000072611 | MORE LIFE RECOVERY CENTER | EXPIRED | 2017-07-05 | 2022-12-31 | No data | 15291 NW 60TH AVE, STE 200, MIAMI LAKES, FL, 33014 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-03-11 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-02-06 | 12555 Orange Drive, Second Floor, Davie, FL 33330 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-06 | 5001 Hollywood Blvd., Hollywood, FL 33021 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-06 | 5001 Hollywood Blvd., Hollywood, FL 33021 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-02-06 | Barnhart, Esq., Valerie | No data |
| LC AMENDMENT | 2018-11-19 | No data | No data |
| REINSTATEMENT | 2016-10-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| LC AMENDMENT | 2016-05-03 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-03-11 |
| AMENDED ANNUAL REPORT | 2019-11-08 |
| AMENDED ANNUAL REPORT | 2019-03-04 |
| ANNUAL REPORT | 2019-02-06 |
| LC Amendment | 2018-11-19 |
| ANNUAL REPORT | 2018-03-28 |
| ANNUAL REPORT | 2017-01-13 |
| REINSTATEMENT | 2016-10-14 |
| LC Amendment | 2016-05-03 |
| Florida Limited Liability | 2015-09-18 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
