| Entity Name: | KETAMINE HEALTH CENTERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 31 Mar 2016 (9 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L16000064036 |
| FEI/EIN Number | 81-2074161 |
| Mail Address: | 5310 Beethoven St, Los Angeles, CA 90066 |
| Address: | 9408 SW 87th Ave, Suite 302, Miami, FL 33176 |
| ZIP code: | 33176 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811488554 | 2018-05-29 | 2023-07-31 | 9408 SW 87TH AVE STE 302, MIAMI, FL, 331762416, US | 9408 SW 87TH AVE STE 302, MIAMI, FL, 331762416, US | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 305-856-9442 |
Authorized person
| Name | RAUL A CRUZ |
| Role | MEDICAL DIRECTOR |
| Phone | 3058569442 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | 607228 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1104163294 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1144421454 |
| State | FL |
| Issuer | MEDICAID |
| Number | 187533935 |
| State | FL |
| Issuer | MEDICAID |
| Number | 1194817221 |
| State | FL |
| Name | Role |
|---|---|
| NORTHWEST REGISTERED AGENT LLC | Agent |
| Name | Role |
|---|---|
| IRWIN NATURALS EMERGENCE, INC. | Authorized Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000060581 | ALIVE NUTRITIONAL IV | EXPIRED | 2018-05-19 | 2023-12-31 | No data | 1430 S. DIXIE HWY, SUITE 204, CORAL GABLES, FL, 33146 |
| G16000085991 | KHC, LLC | ACTIVE | 2016-08-12 | 2026-12-31 | No data | 1 ALHAMBRA PLAZA, SUITE1410, CORAL GABLES, FL, 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-06 | 9408 SW 87th Ave, Suite 302, Miami, FL 33176 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-06 | 7901 4th St N, SUITE 300, St. Petersburg, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-01-06 | Northwest Registered Agent LLC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-21 | 9408 SW 87th Ave, Suite 302, Miami, FL 33176 | No data |
| LC STMNT OF RA/RO CHG | 2016-08-09 | No data | No data |
| LC AMENDMENT AND NAME CHANGE | 2016-07-19 | KETAMINE HEALTH CENTERS, LLC | No data |
| LC DISSOCIATION MEM | 2016-04-18 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2023-01-09 |
| ANNUAL REPORT | 2023-01-06 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-03-30 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-02-09 |
| CORLCRACHG | 2016-08-09 |
| LC Amendment and Name Change | 2016-07-19 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
