| Entity Name: | MEDICUS HEALTH PLAN, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Mar 2005 (20 years ago) |
| Last Event: | REVOCATION OF VOLUNTARY DISSOLUT |
| Event Date Filed: | 27 Apr 2015 (10 years ago) |
| Document Number: | P05000041430 |
| FEI/EIN Number | 202568952 |
| Address: | 9980 Central Park Blv North, Boca Raton, FL, 33428, US |
| Mail Address: | 9980 Central Park Blv North, Boca Raton, FL, 33428, US |
| ZIP code: | 33428 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356818637 | 2018-10-25 | 2018-10-25 | 9980 CENTRAL PARK BLVD N STE 116, BOCA RATON, FL, 334281703, US | 9980 CENTRAL PARK BLVD N STE 116, BOCA RATON, FL, 334281703, US | |||||||||||||||||||||
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| Phone | +1 866-731-6777 |
| Fax | 9548450416 |
Authorized person
| Name | FERNANDO M LOPEZ-IVERN |
| Role | OWNER / M.D |
| Phone | 8667316777 |
Taxonomy
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | OUTPATIENT DETOXIFICATION |
| Number | 1036593 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LOPEZ-IVERN FERNANDO M | Agent | 9980 CENTRAL PARK BLVD. NORTH, BOCA RATON, FL, 33428 |
| Name | Role | Address |
|---|---|---|
| LOPEZ-IVERN FERNANDO M | President | 21055 YACHT CLUB DRIVE,, AVENTURA, FL, 33180 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000073183 | PRIME DETOX | EXPIRED | 2019-07-02 | 2024-12-31 | No data | 9980 N CENTRAL PARK BLVD, SUITE 116, BOCA RATON, FL, 33428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-17 | 9980 Central Park Blv North, SUITE 116B, Boca Raton, FL 33428 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-17 | 9980 Central Park Blv North, SUITE 116B, Boca Raton, FL 33428 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-17 | 9980 CENTRAL PARK BLVD. NORTH, SUITE 116B, BOCA RATON, FL 33428 | No data |
| REVOCATION OF VOLUNTARY DISSOLUT | 2015-04-27 | No data | No data |
| VOLUNTARY DISSOLUTION | 2015-03-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-06 |
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-11 |
| ANNUAL REPORT | 2022-01-12 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-01-23 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
