| Entity Name: | ALPHA THERAPY CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 18 May 2023 (2 years ago) |
| Document Number: | P23000039542 |
| FEI/EIN Number | 93-1459305 |
| Address: | 1840 W 49th St Suite 408, HIALEAH, FL 33012 |
| Mail Address: | 1840 W 49th St Suite 408, HIALEAH, FL 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811778624 | 2023-10-09 | 2024-07-31 | 1840 W 49TH ST STE 408, HIALEAH, FL, 330122978, US | 1840 W 49TH ST STE 408, HIALEAH, FL, 330122978, US | |||||||||||||||||||||||||
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| Phone | +1 305-603-9202 |
| Fax | 3056039203 |
Authorized person
| Name | MAYLIN NURQUE MARTINEZ |
| Role | OWNER |
| Phone | 3056039202 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 120625300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NURQUE, MAYLIN | Agent | 5255 NW 181 TERRACE, MIAMI GARDENS, FL 33055 |
| Name | Role | Address |
|---|---|---|
| NURQUE, MAYLIN | President | 5255 NW 181 TERRACE, MIAMI GARDENS, FL 33055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-08-01 | 1840 W 49th St Suite 408, HIALEAH, FL 33012 | No data |
| CHANGE OF MAILING ADDRESS | 2023-08-01 | 1840 W 49th St Suite 408, HIALEAH, FL 33012 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| Domestic Profit | 2023-05-18 |
Date of last update: 09 Jan 2025
Sources: Florida Department of State
