| Entity Name: | PALM MEDICAL CENTER LITTLE HAVANA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 26 Apr 2017 (8 years ago) |
| Document Number: | L17000093367 |
| FEI/EIN Number | 38-4038275 |
| Mail Address: | 2600 DOUGLAS ROAD, SUITE 308, CORAL GABLES, FL 33134 |
| Address: | 2501 SW 8TH STREET, MIAMI, FL 33135 |
| ZIP code: | 33135 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497271118 | 2017-08-15 | 2018-06-16 | 2600 S DOUGLAS RD STE 308, CORAL GABLES, FL, 331346134, US | 2501 SW 8TH ST, MIAMI, FL, 331353005, US | |||||||||||||||||||||||||||
|
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| Phone | +1 305-913-9447 |
| Fax | 3054421198 |
| Phone | +1 305-642-9992 |
Authorized person
| Name | MRS. MARLEN MORALES |
| Role | COMPLIANCE OFFICER |
| Phone | 3059139447 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | HCC11110 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AGENCY FOR HEALTH CARE ADMINISTRATION LICENSE NUMBER |
| Number | HCC11110 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Prince, Holly | Chief Financial Officer | 2600 DOUGLAS ROAD, SUITE 308 CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| CHOUDHRY, FOWAD | Chief Executive Officer | 2600 DOUGLAS ROAD, SUITE 308 CORAL GABLES, FL 33134 |
| Name | Role | Address |
|---|---|---|
| CASILLAS, PATRICIO | Chief Operating Officer | 2600 DOUGLAS ROAD, SUITE 308 CORAL GABLES, FL 33134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-25 | 801 US HIGHWAY 1, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-14 | 2501 SW 8TH STREET, MIAMI, FL 33135 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-10-02 | 2501 SW 8TH STREET, MIAMI, FL 33135 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| AMENDED ANNUAL REPORT | 2023-10-19 |
| ANNUAL REPORT | 2023-01-19 |
| AMENDED ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2022-01-04 |
| AMENDED ANNUAL REPORT | 2021-10-22 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-03-14 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
