| Entity Name: | DENALI CRT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 02 Nov 1999 (25 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 18 Oct 2017 (7 years ago) |
| Document Number: | L99000007311 |
| FEI/EIN Number | 650958352 |
| Address: | 10200 NW 25th Street, Doral, FL, 33172, US |
| Mail Address: | 10200 NW 25th Street, Doral, FL, 33172, US |
| ZIP code: | 33172 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326480872 | 2013-07-25 | 2024-08-19 | 10200 NW 25TH ST STE 205, DORAL, FL, 331725922, US | 10200 NW 25TH ST STE 205, DORAL, FL, 331725922, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 305-602-0268 |
| Fax | 9544777706 |
Authorized person
| Name | KARINA VICTORIA GOMEZ |
| Role | EXECUTIVE DIRECTOR |
| Phone | 3056028074 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH8888 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 0051701 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 163WC1600X - Continuing Education/Staff Development Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 163WH0200X - Home Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 172A00000X - Driver |
| Is Primary | No |
| Taxonomy Code | 251C00000X - Developmentally Disabled Services Day Training Agency |
| Is Primary | No |
| Taxonomy Code | 343900000X - Non-emergency Medical Transport (VAN) |
| Is Primary | No |
| Taxonomy Code | 374U00000X - Home Health Aide |
| Is Primary | No |
| Taxonomy Code | 376J00000X - Homemaker |
| Is Primary | No |
| Taxonomy Code | 376K00000X - Nurse's Aide |
| Is Primary | No |
| Taxonomy Code | 385H00000X - Respite Care |
| Is Primary | No |
| Taxonomy Code | 385HR2055X - Child Mental Illness Respite Care |
| Is Primary | No |
| Taxonomy Code | 385HR2060X - Child Intellectual and/or Developmental Disabilities Respite Care |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017511700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 693385896 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bonham Gene S | Agent | 10200 NW 25th Street, Doral, FL, 33172 |
| Name | Role | Address |
|---|---|---|
| BLUMTRITT CESAR | President | 10200 NW 25th Street, Doral, FL, 33172 |
| Name | Role | Address |
|---|---|---|
| Gomez Karina V | Authorized Member | 10200 NW 25th Street, Doral, FL, 33172 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-14 | 10200 NW 25th Street, Suite 205, Doral, FL 33172 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-14 | 10200 NW 25th Street, Suite 205, Doral, FL 33172 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-14 | Bonham, Gene S. | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-14 | 10200 NW 25th Street, Suite 205, Doral, FL 33172 | No data |
| REINSTATEMENT | 2017-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2004-12-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| REINSTATEMENT | 2000-10-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-29 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-14 |
| ANNUAL REPORT | 2023-04-14 |
| ANNUAL REPORT | 2022-02-28 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-01-29 |
| ANNUAL REPORT | 2019-01-24 |
| ANNUAL REPORT | 2018-01-17 |
| REINSTATEMENT | 2017-10-18 |
| ANNUAL REPORT | 2016-04-23 |
| ANNUAL REPORT | 2015-03-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
