| Entity Name: | DAZZLING KIDS THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 01 Sep 2017 (7 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 20 Oct 2023 (a year ago) |
| Document Number: | L17000187290 |
| FEI/EIN Number | 82-2685549 |
| Address: | 8470 SW 8 ST, MIAMI, FL, 33144, US |
| Mail Address: | 8470 SW 8 ST, MIAMI, FL, 33144, US |
| ZIP code: | 33144 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780194738 | 2017-10-04 | 2022-08-30 | 8470 SW 8TH ST, MIAMI, FL, 33144, US | 8470 SW 8TH ST, MIAMI, FL, 33144, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 305-603-8105 |
| Fax | 3057034951 |
Authorized person
| Name | MAYLOREN MENDEZ |
| Role | OWNER |
| Phone | 3056038105 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022555200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MAYLOREN MENDEZ | Agent | 8470 SW 8 ST, MIAMI, FL, 33144 |
| Name | Role | Address |
|---|---|---|
| MENDEZ MAYLOREN | Authorized Member | 22723 SW 109TH PATH, MIAMI, FL, 33170 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC STMNT OF RA/RO CHG | 2023-10-20 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-10-20 | 8470 SW 8 ST, MIAMI, FL 33144 | No data |
| CHANGE OF MAILING ADDRESS | 2023-10-20 | 8470 SW 8 ST, MIAMI, FL 33144 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-10-20 | MAYLOREN MENDEZ | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-10-20 | 8470 SW 8 ST, MIAMI, FL 33144 | No data |
| LC DISSOCIATION MEM | 2023-10-03 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| CORLCRACHG | 2023-10-20 |
| CORLCDSMEM | 2023-10-03 |
| ANNUAL REPORT | 2023-02-17 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-04-30 |
| AMENDED ANNUAL REPORT | 2020-05-29 |
| ANNUAL REPORT | 2020-05-28 |
| ANNUAL REPORT | 2019-04-18 |
| ANNUAL REPORT | 2018-04-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
