| Entity Name: | INTEGRATED COMMUNITY SUPPORT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Dec 2019 (5 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 03 Nov 2021 (3 years ago) |
| Document Number: | L19000303347 |
| FEI/EIN Number | 84-4028725 |
| Address: | 13643 SW 26 ST, MIAMI, FL 33175 |
| Mail Address: | 13643 SW 26 ST, MIAMI, FL 33175 |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265072078 | 2020-01-09 | 2021-11-12 | 13643 SW 26TH ST, MIAMI, FL, 331756378, US | 13643 SW 26TH ST, MIAMI, FL, 331756378, US | |||||||||||||||||||||||||
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| Phone | +1 305-400-8281 |
| Fax | 3054008513 |
Authorized person
| Name | JULIO RODRIGUEZ |
| Role | PRESIDENT |
| Phone | 7868185289 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 261QM0801X |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARRILLO, JAX | Agent | 13643 SW 26 ST, MIAMI, FL 33175 |
| Name | Role | Address |
|---|---|---|
| CARRILLO, JAX | Authorized Member | 13643 SW 26 ST, MIAMI, FL 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-11-25 | CARRILLO, JAX | No data |
| LC AMENDMENT | 2021-11-03 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-09-16 | 13643 SW 26 ST, MIAMI, FL 33175 | No data |
| CHANGE OF MAILING ADDRESS | 2021-09-16 | 13643 SW 26 ST, MIAMI, FL 33175 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-09-16 | 13643 SW 26 ST, MIAMI, FL 33175 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-03-29 |
| AMENDED ANNUAL REPORT | 2022-11-25 |
| ANNUAL REPORT | 2022-04-12 |
| LC Amendment | 2021-11-03 |
| AMENDED ANNUAL REPORT | 2021-09-16 |
| ANNUAL REPORT | 2021-04-13 |
| Florida Limited Liability | 2019-12-18 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
