| Entity Name: | SOUTHERN REHABILITATION GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 06 Nov 2018 (6 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | L18000260022 |
| FEI/EIN Number | 83-2547103 |
| Address: | 6447 MIAMI LAKES DR, MIAMI LAKES, FL, 33014, US |
| Mail Address: | 6871 SW 129TH, MIAMI, FL, 33183, US |
| ZIP code: | 33014 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104489079 | 2019-04-17 | 2019-04-17 | 6447 MIAMI LAKES DR E STE 200E, MIAMI LAKES, FL, 330142706, US | 6447 MIAMI LAKES DR E STE 200E, MIAMI LAKES, FL, 330142706, US | |||||||||||||||||||
|
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| Phone | +1 786-319-0748 |
Authorized person
| Name | VIVIAN BLANCO LEZCANO |
| Role | OWNER |
| Phone | 7863190748 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 747907 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLANCO LEZCANO VIVIAN | Agent | 6447 MIAMI LAKES DR, MIAMI LAKES, FL, 33014 |
| Name | Role | Address |
|---|---|---|
| BOFFILL-SENDRANS MARTHA | Vice President | 649 W 36TH STREET, HIALEAH, FL, 33012 |
| Name | Role | Address |
|---|---|---|
| OLAZARRA RODRIGUEZ GABRIEL | Secretary | 6871 SW 129TH AVE, MIAMI, FL, 33183 |
| Name | Role | Address |
|---|---|---|
| LEZCANO VIVIAN B | President | 6871 SW 129TH AVE, MIAMI, FL, 33183 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-23 | 6447 MIAMI LAKES DR, SUITE 200 E, MIAMI LAKES, FL 33014 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-23 | 6447 MIAMI LAKES DR, SUITE 200 E, MIAMI LAKES, FL 33014 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-23 | 6447 MIAMI LAKES DR, SUITE 200 E, MIAMI LAKES, FL 33014 | No data |
| LC AMENDMENT | 2019-01-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-23 |
| LC Amendment | 2019-01-11 |
| Florida Limited Liability | 2018-11-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
