| Entity Name: | BLOSSOM GROUP FLORIDA LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 04 Aug 2021 (4 years ago) |
| Document Number: | L21000351941 |
| FEI/EIN Number | 87-2018139 |
| Address: | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| Mail Address: | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| ZIP code: | 33181 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1598495251 | 2022-06-15 | 2023-07-10 | 2124 NE 123RD ST, #220, NORTH MIAMI, FL, 331813451, US | 2124 NE 123RD ST, #220, NORTH MIAMI, FL, 331813451, US | |||||||||||||||||||||||||
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| Phone | +1 786-828-0947 |
Authorized person
| Name | AMALIA ARIAS |
| Role | PROGRAM MANAGER |
| Phone | 7868280947 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| MOVILLO, FERNANDO , CEO | Agent | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| Name | Role | Address |
|---|---|---|
| MOVILLO, FERNANDO, CEO | Member | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| Name | Role | Address |
|---|---|---|
| MOVILLO, FERNANDO, CEO | Chief Executive Officer | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| Name | Role | Address |
|---|---|---|
| Amalia, Arias | Secretary | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-13 | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-10-12 | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 | No data |
| CHANGE OF MAILING ADDRESS | 2022-10-12 | 2124 NE 123 ST, Suite 220, North Miami, FL 33181 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-04-11 | MOVILLO, FERNANDO , CEO | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-02-13 |
| ANNUAL REPORT | 2022-04-11 |
| Florida Limited Liability | 2021-08-04 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
