| Entity Name: | CERTIFIED SPINE AND PAIN CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 13 Oct 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 17 Oct 2016 (8 years ago) |
| Document Number: | L15000174197 |
| FEI/EIN Number | 475514725 |
| Address: | 1049 S STATE RD 7, Wellington, FL, 33414, US |
| Mail Address: | 1049 S STATE RD 7, Wellington, FL, 33414, US |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982389417 | 2023-06-21 | 2023-06-21 | 1049 S STATE ROAD 7, WELLINGTON, FL, 334146135, US | 6415 LAKE WORTH RD STE 307, GREENACRES, FL, 334632906, US | |||||||||||||
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| Phone | +1 561-578-4582 |
Authorized person
| Name | JORGE GARCIA |
| Role | CREDENTIALING DIRECTOR |
| Phone | 3056060337 |
Taxonomy
| Taxonomy Code | 207LP2900X - Pain Medicine (Anesthesiology) Physician |
| Is Primary | Yes |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300GSAHVPBGPU4Q65 | L15000174197 | US-FL | GENERAL | ACTIVE | 2015-10-13 | |||||||||||||||||||
|
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| Legal | C/O MALDONADO, EDWIN W, 1211 CREEKSIDE DR, WELLINGTON, US-FL, US, 33414 |
| Headquarters | 160 Congress Park Drive Unit 101, Delray Beach, US-FL, US, 33445 |
Registration details
| Registration Date | 2022-06-24 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2023-06-23 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | L15000174197 |
| Name | Role | Address |
|---|---|---|
| MALDONADO EDWIN W | Agent | 1211 CREEKSIDE DR, WELLINGTON, FL, 33414 |
| Name | Role | Address |
|---|---|---|
| EDWIN MALDONADO WDR | Manager | 1211 CREKSIDE DR, WELLINGTON, FL, 33414 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000021538 | CERTIFIED SPINE AND PAIN CARE, LLC | EXPIRED | 2017-02-28 | 2022-12-31 | No data | 3345 BURNS ROAD, SUITE 202, PALM BEACH GARDENS, FL, 33410 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-06-06 | 1049 S STATE RD 7, Wellington, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2019-06-06 | 1049 S STATE RD 7, Wellington, FL 33414 | No data |
| REINSTATEMENT | 2016-10-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-17 | MALDONADO, EDWIN W | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-07-26 |
| ANNUAL REPORT | 2020-01-16 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-01 |
| ANNUAL REPORT | 2017-03-15 |
| REINSTATEMENT | 2016-10-17 |
| Florida Limited Liability | 2015-10-13 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
