| Entity Name: | MENTAL CARE MEDICAL CENTER INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 14 Jul 2020 (5 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 05 Aug 2020 (5 years ago) |
| Document Number: | P20000052907 |
| FEI/EIN Number | 85-1963011 |
| Address: | 7925 NW 12TH ST., SUITE 225, DORAL, FL 33126 |
| Mail Address: | 7925 NW 12TH ST., SUITE 225, DORAL, FL 33126 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154932457 | 2020-08-11 | 2023-06-26 | 7925 NW 12TH ST STE 225, DORAL, FL, 331261821, US | 7925 NW 12TH ST STE 225, DORAL, FL, 331261821, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 305-788-6644 |
Authorized person
| Name | PEDRO A AMADOR RODRIGUEZ |
| Role | OWNER/PRESIDENT |
| Phone | 3057886644 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 110034600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 117263400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 107706300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AMADOR RODRIGUEZ, PEDRO ANTONIO | Agent | 7925 NW 12TH ST., SUITE 225, DORAL, FL 33126 |
| Name | Role | Address |
|---|---|---|
| AMADOR RODRIGUEZ, PEDRO ANTONIO | President | 7925 NW 12TH ST., SUITE 225, DORAL, FL 33126 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000124976 | MEDICAL CARE CENTER GROUP INC | ACTIVE | 2022-10-05 | 2027-12-31 | No data | 7925 NW 12 ST SUIT 225, DORAL, FL, 33126 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2020-08-05 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-08-05 | AMADOR RODRIGUEZ, PEDRO ANTONIO | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-03-06 |
| Amendment | 2020-08-05 |
| Domestic Profit | 2020-07-14 |
Date of last update: 15 Feb 2025
Sources: Florida Department of State
