| Entity Name: | DOMUS CARE SOLUTIONS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Oct 2019 (5 years ago) |
| Document Number: | L19000264672 |
| FEI/EIN Number | 84-3638733 |
| Address: | 2200 N COMMERCE PKWY STE 200, WESTON, FL 33326 |
| Mail Address: | 2200 N COMMERCE PKWY, STE 200, WESTON, FL 33326 |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285264093 | 2020-01-21 | 2020-01-21 | 2200 N COMMERCE PKWY STE 200, WESTON, FL, 333263258, US | 2200 N COMMERCE PKWY STE 200, WESTON, FL, 333263258, US | |||||||||||||||||||||||||
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| Phone | +1 718-406-4896 |
| Fax | 9545292001 |
Authorized person
| Name | RAFAEL OSVALDO HERNANDEZ LORA |
| Role | OWNER/PHYSICIAN |
| Phone | 7184064896 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDABLUE |
| Number | IHBP9 |
| State | FL |
| Name | Role |
|---|---|
| ACCUTAX ADVISORY CORP. | Agent |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ LORA, RAFAEL | Manager | 2200 N COMMERCE PKWY, STE 200 WESTON, FL 33326 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000144863 | NEST MEDICAL CENTER | ACTIVE | 2024-11-29 | 2029-12-31 | No data | 3161 SW 160TH AVE, MIRAMAR, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-02-02 | 2200 N COMMERCE PKWY STE 200, WESTON, FL 33326 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-11-29 | 2200 N COMMERCE PKWY STE 200, WESTON, FL 33326 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-30 | ACCUTAX ADVISORY CORP | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-30 | 11098 BISCAYNE BLVD, 206, MIAMI, FL 33161 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-02-02 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-30 |
| Florida Limited Liability | 2019-10-22 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
