| Entity Name: | NOVELLAS'S HEALTH CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 22 Apr 2020 (5 years ago) |
| Document Number: | L20000109921 |
| FEI/EIN Number | 85-2118366 |
| Mail Address: | 501 NW 76TH TER, PEMBROKE PINES, FL 33024 |
| Address: | 17855 NW 78th AVE, HIALEAH, FL 33015 |
| ZIP code: | 33015 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1295468684 | 2022-07-05 | 2022-09-21 | 17855 NW 78TH AVE, HIALEAH, FL, 330152805, US | 17855 NW 78TH AVE, HIALEAH, FL, 330152805, US | |||||||||||||||||||||
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| Phone | +1 305-530-8979 |
| Fax | 3055308979 |
Authorized person
| Name | DR. JORGE NOVELLAS ZAYAS |
| Role | OWNER |
| Phone | 7867173164 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1053920173 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NOVELLAS, JORGE, DR. | Agent | 501 NW 76TH TER, PEMBROKE PINES, FL 33024 |
| Name | Role | Address |
|---|---|---|
| NOVELLAS, JORGE, DR. | Manager | 501 NW 76TH TER, PEMBROKE PINES, FL 33024 |
| Name | Role | Address |
|---|---|---|
| Martinez, Yurielis | Authorized Representative | 501 NW 76TH TER, PEMBROKE PINES, FL 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-04 | 17855 NW 78th AVE, HIALEAH, FL 33015 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-04-04 | 501 NW 76TH TER, PEMBROKE PINES, FL 33024 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-07-28 | 17855 NW 78th AVE, HIALEAH, FL 33015 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-01-19 |
| Florida Limited Liability | 2020-04-22 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
