| Entity Name: | BREVARD WOUND CARE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Nov 2020 (4 years ago) |
| Document Number: | L20000363461 |
| FEI/EIN Number | 85-4089037 |
| Address: | 445 PINEDA COURT, MELBOURNE, FL, 32940, US |
| Mail Address: | 445 PINEDA COURT, MELBOURNE, FL, 32940, US |
| ZIP code: | 32940 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154910271 | 2021-01-13 | 2021-01-13 | 445 PINEDA CT, MELBOURNE, FL, 329407555, US | 445 PINEDA CT, MELBOURNE, FL, 329407555, US | |||||||||||||||
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| Phone | +1 321-254-1611 |
| Fax | 3212543166 |
Authorized person
| Name | MIGUEL MATEOS-MORA |
| Role | OWNER/OPERATOR |
| Phone | 3212541611 |
Taxonomy
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ANDERSON J. PATRICK | Agent | 2200 FRONT STREET STE 301, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| MATEOS-MORA MIGUEL M.D. | Authorized Member | 445 PINEDA COURT, MELBOURNE, FL, 32940 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-12 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-04-01 |
| Florida Limited Liability | 2020-11-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
