| Entity Name: | COMPLEX CARE OF CENTRAL FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Sep 2020 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Oct 2021 (3 years ago) |
| Document Number: | L20000273684 |
| FEI/EIN Number | 85-2675276 |
| Address: | 508 SWEETWATER CLUB CIRCLE, LONGWOOD, FL, 32779 |
| Mail Address: | 508 SWEETWATER CLUB CIRCLE, LONGWOOD, FL, 32779 |
| ZIP code: | 32779 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114530664 | 2020-08-25 | 2023-02-26 | 508 SWEETWATER CLUB CIR, LONGWOOD, FL, 327792131, US | 508 SWEETWATER CLUB CIR, LONGWOOD, FL, 327792131, US | |||||||||||||||||||||||
|
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| Phone | +1 407-463-5848 |
Authorized person
| Name | DR. CHRISTIAN A CHABAN |
| Role | OWNER |
| Phone | 4074635848 |
Taxonomy
| Taxonomy Code | 208000000X - Pediatrics Physician |
| Is Primary | Yes |
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 018470900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHABAN CHRISTIAN AMD | Agent | 508 SWEETWATER CLUB CIRCLE, LONGWOOD, FL, 32779 |
| Name | Role | Address |
|---|---|---|
| CHABAN CHRISTIAN AMD | Manager | 508 SWEETWATER CLUB CIRCLE, LONGWOOD, FL, 32779 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-10-04 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-10-04 | CHABAN, CHRISTIAN A, MD | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-09-16 |
| ANNUAL REPORT | 2022-07-11 |
| REINSTATEMENT | 2021-10-04 |
| Florida Limited Liability | 2020-09-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
