| Entity Name: | HOLY CROSS MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 16 Sep 2020 (4 years ago) |
| Document Number: | L20000290379 |
| FEI/EIN Number | 853021818 |
| Address: | 4109 N ARMENIA AVE, SUITE A, TAMPA, FL, 33607, US |
| Mail Address: | 4109 N ARMENIA AVE, SUITE A, TAMPA, FL, 33607, US |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174118608 | 2021-03-05 | 2024-04-22 | 4109 N ARMENIA AVE STE A, TAMPA, FL, 336076411, US | 4109 N ARMENIA AVE STE A, TAMPA, FL, 336076411, US | |||||||||||||||||||||||||||
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| Phone | +1 813-588-3342 |
| Fax | 8135883602 |
Authorized person
| Name | ESTRELLA GONZALEZ |
| Role | CEO |
| Phone | 8135883342 |
Taxonomy
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 120219100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 111242300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ ESTRELLA A | Agent | 4109 N ARMENIA AVE, TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ ESTRELLA A | Authorized Member | 4109 N ARMENIA AVE, TAMPA, FL, 33607 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000009419 | DACONA MEDICAL CENTER | ACTIVE | 2022-01-10 | 2027-12-31 | No data | 4109 N ARMENIA AVE, SUITE A T, TAMPA, FL, 33607 |
| G20000125628 | HOLY CROSS MEDICAL CENTER LLC | ACTIVE | 2020-09-28 | 2025-12-31 | No data | 7512 N OLA AVE, TAMPA, FL, 33604 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-01-19 | 4109 N ARMENIA AVE, SUITE A, TAMPA, FL 33607 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-20 | 4109 N ARMENIA AVE, SUITE A, TAMPA, FL 33607 | No data |
| CHANGE OF MAILING ADDRESS | 2022-01-20 | 4109 N ARMENIA AVE, SUITE A, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-26 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-20 |
| ANNUAL REPORT | 2021-03-23 |
| Florida Limited Liability | 2020-09-16 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
