| Entity Name: | AMALIA'S COMMUNITY CLINIC, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Mar 2019 (6 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P19000022773 |
| FEI/EIN Number | 834164012 |
| Address: | 5400 SOUTH UNIVERSITY DRIVE, DAVIE, FL, 33328, US |
| Mail Address: | 5400 SOUTH UNIVERSITY DRIVE, DAVIE, FL, 33328, US |
| ZIP code: | 33328 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881349660 | 2022-02-19 | 2022-02-19 | 9440 NW 35TH CT, MIAMI, FL, 331472730, US | 5400 S UNIVERSITY DR STE 217, DAVIE, FL, 333285310, US | |||||||||||||||||||||
|
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| Phone | +1 786-230-5396 |
| Phone | +1 954-900-2931 |
Authorized person
| Name | LIDICE GISEL CARRILLO CABRERA |
| Role | ADMINISTRATOR |
| Phone | 9549002931 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 107149700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOMEZ GUILLEN GERMAN | Agent | 5400 SOUTH UNIVERSITY DRIVE, DAVIE, FL, 33328 |
| Name | Role | Address |
|---|---|---|
| GOMEZ GUILLEN GERMAN | President | 5400 SOUTH UNIVERSITY DRIVE, DAVIE, FL, 33328 |
| Name | Role | Address |
|---|---|---|
| CARRILLO CABRERA LIDICE G | Vice President | 5400 SOUTH UNIVERSITY DRIVE, DAVIE, FL, 33328 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| AMENDMENT | 2019-11-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-11-04 | 5400 SOUTH UNIVERSITY DRIVE, #217, DAVIE, FL 33328 | No data |
| CHANGE OF MAILING ADDRESS | 2019-11-04 | 5400 SOUTH UNIVERSITY DRIVE, #217, DAVIE, FL 33328 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-02-03 |
| ANNUAL REPORT | 2020-03-01 |
| Amendment | 2019-11-04 |
| Domestic Profit | 2019-03-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
