| Entity Name: | EXCELLENCE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Oct 2003 (21 years ago) |
| Date of dissolution: | 16 Sep 2005 (19 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 16 Sep 2005 (19 years ago) |
| Document Number: | P03000111611 |
| FEI/EIN Number | 300208843 |
| Address: | 5590 WEST 20 AVENUE, SUITE 201, HIALEAH, FL, 33016 |
| Mail Address: | 5590 WEST 20 AVENUE, SUITE 201, HIALEAH, FL, 33016 |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740440577 | 2008-06-16 | 2008-06-16 | 1235 N KROME AVE, HOMESTEAD, FL, 330304204, US | 1235 N KROME AVE, HOMESTEAD, FL, 330304204, US | |||||||||||||||||||||||||
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| Phone | +1 305-242-5336 |
| Fax | 3052425337 |
Authorized person
| Name | DR. NILDA ROSE ACOSTA |
| Role | PRESIDENT CEO |
| Phone | 3052425336 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME0061179 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 264034100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LORENZO YALEXIS L | Agent | 560 NORTH SHORE DRIVE, MIAMI BEACH, FL, 33141 |
| Name | Role | Address |
|---|---|---|
| LORENZO YALEXIS L | President | 560 NORTH SHORE DRIVE, MIAMI BEACH, FL, 33141 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2004-04-27 |
| Domestic Profit | 2003-10-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
