| Entity Name: | NORLAND RES HAB, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 27 Jun 2018 (7 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 08 Aug 2019 (6 years ago) |
| Document Number: | L18000157919 |
| FEI/EIN Number | 83-1118265 |
| Address: | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 |
| Mail Address: | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 |
| ZIP code: | 33055 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1790151314 | 2015-08-18 | 2022-02-22 | 19615 NW 12TH CT., MIAMI, FL, 33169, US | 19615 NW 12TH CT, MIAMI, FL, 331693080, US | |||||||||||||||||||||||||||||
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| Phone | +1 305-974-4230 |
| Fax | 3059744143 |
| Phone | +1 305-653-0918 |
| Fax | 3056531720 |
Authorized person
| Name | EUFRACIA URENA |
| Role | PRESIDENT |
| Phone | 3059744230 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| License Number | 11-236-GH |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 675403196 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| URENA, EUFRACIA | Agent | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 |
| Name | Role | Address |
|---|---|---|
| URENA, EUFRACIA | President | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 |
| Name | Role | Address |
|---|---|---|
| URENA, EUFRACIA | Director | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 |
| Name | Role | Address |
|---|---|---|
| DIJOLS, PEDRO E | Vice President | 612 SE 5Th Ave, Suite #3 Fort Lauderdale, FL 33301 |
| Name | Role | Address |
|---|---|---|
| FRIAS, MIRELLA M | Secretary | 7470 NW 176TH ST, HIALEAH, FL 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-30 | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-30 | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-30 | 5431 NW 175 ST, MIAMI GARDENS, FL 33055 | No data |
| LC AMENDMENT | 2019-08-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-04-16 |
| ANNUAL REPORT | 2020-02-13 |
| LC Amendment | 2019-08-08 |
| ANNUAL REPORT | 2019-04-05 |
| Florida Limited Liability | 2018-06-27 |
Date of last update: 17 Feb 2025
Sources: Florida Department of State
