| Entity Name: | MASTERPIECE BEHAVIORAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Jan 2016 (9 years ago) |
| Document Number: | L16000017255 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 12150 SW 128 COURT, MIAMI, FL, 33186, US |
| Mail Address: | 12150 SW 128 COURT, 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 | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083066971 | 2016-07-05 | 2023-06-22 | 12150 SW 128TH CT STE 108, MIAMI, FL, 331864648, US | 12150 SW 128TH CT STE 108, MIAMI, FL, 331864648, US | |||||||||||||||||||||||||||||||||
|
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| Phone | +1 786-732-0607 |
| Fax | 7867320637 |
Authorized person
| Name | MADIANE PEREZ |
| Role | MANAGER |
| Phone | 3052445085 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH 10803 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | BACB 1-15-21803 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003762900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ MADIANE | Agent | 12150 SW 128 COURT, MIAMI, FL, 33186 |
| Name | Role | Address |
|---|---|---|
| PEREZ MADIANE | Authorized Member | 12150 SW 128 COURT, MIAMI, FL, 33186 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-18 | 12150 SW 128 COURT, SUITE 108, MIAMI, FL 33186 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-18 | 12150 SW 128 COURT, SUITE 108, MIAMI, FL 33186 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-18 | 12150 SW 128 COURT, SUITE 108, MIAMI, FL 33186 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-14 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-03-28 |
| ANNUAL REPORT | 2021-03-18 |
| ANNUAL REPORT | 2020-05-28 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-03-06 |
| ANNUAL REPORT | 2017-04-08 |
| Florida Limited Liability | 2016-01-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
