| Entity Name: | 1ST CLASS PHYSICAL MEDICINE AND REHABILITATION LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Apr 2016 (9 years ago) |
| Date of dissolution: | 27 Mar 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Mar 2018 (7 years ago) |
| Document Number: | L16000076243 |
| FEI/EIN Number | 471316706 |
| Address: | 15475 SE 36TH AVE, SUMMERFIELD, FL, 34491, US |
| Mail Address: | 15475 SE 36TH AVE, SUMMERFIELD, FL, 34491, US |
| ZIP code: | 34491 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144637018 | 2014-07-12 | 2017-03-10 | 2141 NE 2ND ST, OCALA, FL, 344706950, US | 2275 SW 22ND LN, OCALA, FL, 344717710, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 419-573-2505 |
| Phone | +1 352-387-9889 |
Authorized person
| Name | MELISSA MARIE ALVAREZ PEREZ |
| Role | OWNER |
| Phone | 4195732505 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME124242 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0106786 |
| State | OH |
| Name | Role | Address |
|---|---|---|
| ALVAREZ PEREZ MELISSA MMS | Agent | 14189 NE 252nd Court Road 108, Salt Springs, FL, 32134 |
| Name | Role | Address |
|---|---|---|
| ALVAREZ PEREZ MELISSA MMS | Manager | 14189 NE 252nd Court Road 108, Salt Springs, FL, 32134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-03-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-08-23 | 15475 SE 36TH AVE, SUMMERFIELD, FL 34491 | No data |
| CHANGE OF MAILING ADDRESS | 2017-08-23 | 15475 SE 36TH AVE, SUMMERFIELD, FL 34491 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-01-08 | 14189 NE 252nd Court Road 108, Salt Springs, FL 32134 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2018-03-27 |
| ANNUAL REPORT | 2017-01-08 |
| Florida Limited Liability | 2016-04-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
