| Entity Name: | GALAXY WELLNESS & ORTHO-SPINE CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 15 Aug 2018 (7 years ago) |
| Document Number: | L18000195183 |
| FEI/EIN Number | 83-1588669 |
| Address: | 9772 SW 24TH STREET, MIAMI, FL 33165 |
| Mail Address: | 9772 SW 24TH STREET, MIAMI, FL 33165 |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861957425 | 2019-02-07 | 2019-04-02 | 9774 SW 24TH ST, MIAMI, FL, 331657574, US | 9774 SW 24TH ST, MIAMI, FL, 331657574, US | |||||||||||||||||||||||
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| Phone | +1 786-536-2377 |
| Fax | 8888622545 |
| Phone | +1 865-362-3777 |
Authorized person
| Name | JOSE ALLENDE |
| Role | MANAGER |
| Phone | 7865362377 |
Taxonomy
| Taxonomy Code | 207X00000X - Orthopaedic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0270619900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PONCE DE LEON, JOSE L, MD | Agent | 9774 sw 24 st, miami, FL 33165 |
| Name | Role | Address |
|---|---|---|
| PONCE DE LEON, JOSE LUIS, MD | Manager | 9774 SW 24 ST, MIAMI, FL 33165 |
| Name | Role | Address |
|---|---|---|
| CEPEDA, JORGE A | Authorized Member | 9774 SW 24 ST, MIAMI, FL 33165 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-12-26 | 9772 SW 24TH STREET, MIAMI, FL 33165 | No data |
| CHANGE OF MAILING ADDRESS | 2024-12-26 | 9772 SW 24TH STREET, MIAMI, FL 33165 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-30 | 9774 sw 24 st, miami, FL 33165 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-02-07 | 9774 SW 24 ST, MIAMI, FL 33165 | No data |
| CHANGE OF MAILING ADDRESS | 2019-02-07 | 9774 SW 24 ST, MIAMI, FL 33165 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-02-14 |
| ANNUAL REPORT | 2021-07-28 |
| ANNUAL REPORT | 2020-06-24 |
| ANNUAL REPORT | 2019-04-30 |
| Florida Limited Liability | 2018-08-15 |
Date of last update: 17 Feb 2025
Sources: Florida Department of State
