| Entity Name: | COMPLETE HEALTH OF SOUTH FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Nov 2020 (4 years ago) |
| Document Number: | L20000346521 |
| FEI/EIN Number | 853885132 |
| Address: | 1150 NW 72 AVE, MIAMI, FL, 33126, US |
| Mail Address: | 1150 NW 72 AVE, MIAMI, FL, 33126, US |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275138620 | 2020-12-03 | 2024-08-12 | 1150 NW 72ND AVE, MIAMI, FL, 331261936, US | 1150 NW 72ND AVE STE 640, MIAMI, FL, 331261921, US | |||||||||||||||||||||||||||
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| Phone | +1 786-653-7131 |
| Fax | 7867064900 |
| Phone | +1 786-497-3444 |
Authorized person
| Name | CARLOS DIAZ |
| Role | OWNER |
| Phone | 7865061786 |
Taxonomy
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108841600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DIAZ CARLOS | Agent | 1150 NW 72 AVE, MIAMI, FL, 33126 |
| Name | Role | Address |
|---|---|---|
| LOPEZ BARBARA V | Manager | 1150 NW 72 AVE, MIAMI, FL, 33126 |
| DIAZ CARLOS | Manager | 1150 NW 72 AVE, MIAMI, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-15 | 1150 NW 72 AVE, SUITE 640, MIAMI, FL 33126 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-15 | 1150 NW 72 AVE, SUITE 640, MIAMI, FL 33126 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-01-15 | DIAZ, CARLOS | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-15 | 1150 NW 72 AVE, SUITE 640, MIAMI, FL 33126 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-15 |
| ANNUAL REPORT | 2023-04-27 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-04-19 |
| Florida Limited Liability | 2020-11-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
