| Entity Name: | DIVINE LEISURE & ACTIVITY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 05 Dec 2017 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 02 Aug 2019 (6 years ago) |
| Document Number: | L17000249176 |
| FEI/EIN Number | 823631318 |
| Address: | 6500 WEST 4TH AVENUE, HIALEAH, FL, 33012, US |
| Mail Address: | 6500 WEST 4TH AVENUE, HIALEAH, FL, 33012, US |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679174924 | 2020-11-03 | 2020-11-03 | 5355 W 7TH CT, HIALEAH, FL, 330122518, US | 6500 W 4TH AVE STE 26, HIALEAH, FL, 330126606, US | |||||||||||||||||||
|
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| Phone | +1 786-413-8657 |
Authorized person
| Name | MRS. EMILENES DOMINGUEZ |
| Role | OWNER |
| Phone | 7864138657 |
Taxonomy
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9482 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DOMINGUEZ EMILENES | Agent | 5355 WEST 7TH COURT, HIALEAH, FL, 33012 |
| Name | Role | Address |
|---|---|---|
| DOMINGUEZ EMILENES | Manager | 5355 WEST 7TH COURT, HIALEAH, FL, 33012 |
| MARTINEZ SANTANA JOSE A | Manager | 5355 WEST 7TH COURT, HIALEAH, FL, 33012 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2019-08-02 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-06 | 6500 WEST 4TH AVENUE, STE. 26, HIALEAH, FL 33012 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-06 | 6500 WEST 4TH AVENUE, STE. 26, HIALEAH, FL 33012 | No data |
| LC AMENDMENT | 2018-01-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-01-27 |
| ANNUAL REPORT | 2022-02-23 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-01-24 |
| LC Amendment | 2019-08-02 |
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-04-09 |
| LC Amendment | 2018-01-23 |
| Florida Limited Liability | 2017-12-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
