| Entity Name: | CHEN NEIGHBORHOOD MEDICAL OF SOUTH LAKELAND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Mar 2016 (9 years ago) |
| Document Number: | L16000043356 |
| FEI/EIN Number | 32-0488609 |
| Address: | 1395 NW 167th St, Miami Gardens, FL, 33169, US |
| Mail Address: | 1395 NW 167th St, Miami Gardens, FL, 33169, US |
| ZIP code: | 33169 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801258447 | 2016-03-23 | 2016-06-01 | 1395 NW 167TH ST, MIAMI GARDENS, FL, 331695742, US | 4715 S FLORIDA AVE, LAKELAND, FL, 338132101, US | |||||||||||||||||
|
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| Phone | +1 305-628-6117 |
Authorized person
| Name | DINA VALLADARES |
| Role | MANAGER OF CREDENTIALING |
| Phone | 3058314760 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| Is Primary | No |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| CHEN CHRISTOPHER | Auth | 1395 NW 167th St, Miami Gardens, FL, 33169 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000100820 | DEDICATED SENIOR MEDICAL CENTER | ACTIVE | 2016-09-14 | 2026-12-31 | No data | 1395 NW 167TH STREET, MIAMI, FL, 33169 |
| G16000055754 | DEDICATED SENIOR HEALTHCARE | ACTIVE | 2016-06-06 | 2026-12-31 | No data | 1395 NW 167TH STREET, MIAMI, FL, 33169 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-19 | 1395 NW 167th St, Miami Gardens, FL 33169 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-19 | 1395 NW 167th St, Miami Gardens, FL 33169 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-06-07 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-06-07 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-19 |
| Reg. Agent Change | 2022-06-07 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-03-16 |
| AMENDED ANNUAL REPORT | 2019-11-01 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-13 |
| AMENDED ANNUAL REPORT | 2017-12-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
