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PALM MEDICAL CENTER PLANTATION LLC

Company Details

Entity Name: PALM MEDICAL CENTER PLANTATION LLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 14 Jun 2017 (8 years ago)
Last Event: LC AMENDMENT
Event Date Filed: 25 Oct 2024 (3 months ago)
Document Number: L17000129990
FEI/EIN Number 61-1852061
Address: 6971 W SUNRISE BLVD, STE 105-106, PLANTATION, FL, 33313, US
Mail Address: 2600 DOUGLAS RD, SUITE 308, CORAL GABLES, FL, 33134, US
ZIP code: 33313
County: Broward
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1417458464 2018-02-26 2019-06-11 2600 S DOUGLAS RD STE 308, CORAL GABLES, FL, 331346134, US 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 333134407, US

Contacts

Phone +1 305-913-9444
Fax 3054421198
Phone +1 954-583-3500

Authorized person

Name MR. JUAN M ORTIZ
Role CEO
Phone 3059139444

Taxonomy

Taxonomy Code 261Q00000X - Clinic/Center
Is Primary Yes

Agent

Name Role
CORPORATE CREATIONS NETWORK INC. Agent

Vice President

Name Role Address
LEAL JUAN Vice President 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Founder

Name Role Address
LEAL JUAN Founder 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Executive Producer

Name Role Address
LEAL JUAN Executive Producer 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Administrator

Name Role Address
LEAL JUAN Administrator 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Chief Executive Officer

Name Role Address
CHOUDHRY FOWAD Chief Executive Officer 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Chief Operating Officer

Name Role Address
CASILLAS PATRICIO Chief Operating Officer 6971 W SUNRISE BLVD STE 105-106, PLANTATION, FL, 33313

Events

Event Type Filed Date Value Description
LC AMENDMENT 2024-10-25 No data No data
CHANGE OF MAILING ADDRESS 2023-10-19 6971 W SUNRISE BLVD, STE 105-106, PLANTATION, FL 33313 No data
REGISTERED AGENT ADDRESS CHANGED 2020-03-25 801 US HIGHWAY 1, NORTH PALM BEACH, FL 33408 No data
CHANGE OF PRINCIPAL ADDRESS 2019-09-14 6971 W SUNRISE BLVD, STE 105-106, PLANTATION, FL 33313 No data

Documents

Name Date
LC Amendment 2024-10-25
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
ANNUAL REPORT 2021-01-14
ANNUAL REPORT 2020-01-17
ANNUAL REPORT 2019-02-08
ANNUAL REPORT 2018-03-14

Date of last update: 01 Feb 2025

Sources: Florida Department of State