| Entity Name: | STEPHANIE M CRUZ, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Mar 2017 (8 years ago) |
| Document Number: | L17000065038 |
| FEI/EIN Number | 82-0942516 |
| Address: | 4741 OLD CANOE CREEK RD, ST. CLOUD, FL, 34769, US |
| Mail Address: | 3430 GOLDENEYE LN, ST. CLOUD, FL, 34772, US |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588295190 | 2020-02-01 | 2024-01-11 | 3430 GOLDENEYE LN, SAINT CLOUD, FL, 347727765, US | 4741 OLD CANOE CREEK RD, SAINT CLOUD, FL, 347691400, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-715-2099 |
| Fax | 4078915040 |
Authorized person
| Name | STEPHANIE MARIE CRUZ |
| Role | MENTAL HEALTH COUNSELOR |
| Phone | 4077152099 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018959000 |
| State | FL |
| Issuer | MEDICAID |
| Number | 106154500 |
| State | FL |
| Name | Role |
|---|---|
| EDWIN RIVERA & ASSOCIATES, CPA, PA | Agent |
| Name | Role | Address |
|---|---|---|
| CRUZ STEPHANIE M | Manager | 3430 GOLDENEYE LN, ST. CLOUD, FL, 34772 |
| Name | Role | Address |
|---|---|---|
| Merari Renta | Auth | 1807 Bluepoint St., Saint Cloud, FL, 34771 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000025048 | SUNBEAM MENTAL CARE | ACTIVE | 2020-02-26 | 2025-12-31 | No data | 3282 CANOE CREEK RD., SAINT CLOUD, FL, 34772 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-13 | 4741 OLD CANOE CREEK RD, ST. CLOUD, FL 34769 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-02-10 |
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-02-11 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-03-26 |
| Florida Limited Liability | 2017-03-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
