| Entity Name: | GALLOWAY THERAPY SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 04 Jun 1997 (28 years ago) |
| Document Number: | P97000052790 |
| FEI/EIN Number | 650784270 |
| Address: | 9280 SW Hammocks Blvd, MIAMI, FL, 33196, US |
| Mail Address: | 9280 SW Hammocks Blvd, MIAMI, FL, 33196, US |
| ZIP code: | 33196 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447676820 | 2014-03-10 | 2014-03-10 | 946 NE 96TH ST, MIAMI SHORES, FL, 331382524, US | 9280 HAMMOCKS BLVD, 106, MIAMI, FL, 331961507, US | |||||||||||||||||||||||||||
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| Phone | +1 305-934-6454 |
| Fax | 3057569527 |
| Phone | +1 305-383-3348 |
Authorized person
| Name | ERNESTO PEREZ |
| Role | ADMIN/OWNER |
| Phone | 3059346454 |
Taxonomy
| Taxonomy Code | 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| License Number | 10-3247 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004696000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ ERNESTO | Agent | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| PEREZ ERNESTO | President | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| PEREZ ERNESTO | Vice President | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| PEREZ ERNESTO | Secretary | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| PEREZ Yadira A | Director | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Name | Role | Address |
|---|---|---|
| PEREZ ERNESTO | Treasurer | 9280 SW Hammocks Blvd, MIAMI, FL, 33196 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| AMENDMENT | 2010-06-10 | No data | No data |
| AMENDMENT | 2004-06-25 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
