| Entity Name: | LEGACY MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 21 Jan 2021 (4 years ago) |
| Date of dissolution: | 27 Sep 2024 (5 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (5 months ago) |
| Document Number: | L21000041480 |
| FEI/EIN Number | 86-2157187 |
| Address: | 8356 SW 40 St, STE A,B, MIAMI, FL 33155 |
| Mail Address: | 8356 SW 40 ST, STE A,B, MIAMI, FL 33155 |
| ZIP code: | 33155 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700465226 | 2021-04-02 | 2022-05-18 | 6741 SW 24TH ST STE 46, MIAMI, FL, 331551767, US | 6741 SW 24TH ST STE 46, MIAMI, FL, 331551767, US | |||||||||||||||||||||||
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| Phone | +1 786-427-7059 |
Authorized person
| Name | ALFREDO CUBA |
| Role | CEO |
| Phone | 7862633100 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101681100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CUBA, ALFREDO | Agent | 8356 SW 40 St, STE A,B, MIAMI, FL 33155 |
| Name | Role | Address |
|---|---|---|
| CUBA, ALFREDO | Manager | 8356 SW, 40 ST STE A,B MIAMI, FL 33155 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-28 | 8356 SW 40 St, STE A,B, MIAMI, FL 33155 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-28 | 8356 SW 40 St, STE A,B, MIAMI, FL 33155 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-28 | 8356 SW 40 St, STE A,B, MIAMI, FL 33155 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-29 | CUBA, ALFREDO | No data |
| LC AMENDMENT | 2021-07-08 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-29 |
| LC Amendment | 2021-07-08 |
| Florida Limited Liability | 2021-01-21 |
Date of last update: 14 Feb 2025
Sources: Florida Department of State
