| Entity Name: | BREVARD UNIVERSAL CLINICAL SERVICES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Oct 2023 (a year ago) |
| Document Number: | L23000465136 |
| FEI/EIN Number | 93-3899578 |
| Address: | 1385 CYPRESS AVENUE, MELBOURNE, FL, 32935, US |
| Mail Address: | 500 Palm Springs Blvd,, Indian Harbor Beach, FL, 32937, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902644644 | 2024-07-17 | 2024-07-17 | 1385 CYPRESS AVE UNIT 107, MELBOURNE, FL, 329355919, US | 1385 CYPRESS AVE UNIT 107, MELBOURNE, FL, 329355919, US | |||||||||||||
|
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| Phone | +1 973-886-0045 |
Authorized person
| Name | ANDREW GROSSMAN |
| Role | OWNER |
| Phone | 9738860045 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| INC AUTHORITY RA | Agent | 390 NORTH ORANGE AVE., STE 2300-N, ORLANDO, FL, 32801 |
| Name | Role | Address |
|---|---|---|
| GROSSMAN ANDREW | Manager | 500 Palm Springs Blvd,, Indian Harbor Beach, FL, 32937 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-05-20 | 1385 CYPRESS AVENUE, suite 107, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2024-05-20 | 1385 CYPRESS AVENUE, suite 107, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-20 |
| Florida Limited Liability | 2023-10-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
