| Entity Name: | LICE SOURCE SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 27 Jan 1998 (27 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 14 Nov 2013 (11 years ago) |
| Document Number: | P98000008380 |
| FEI/EIN Number | 65-0810436 |
| Address: | 13500 Southwest 88th Street, Suite 175, Miami, FL 33186 |
| Mail Address: | 13500 SW 88th Street, 175, Miami, FL 33186 |
| ZIP code: | 33186 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508092263 | 2009-06-08 | 2011-10-03 | 6971 W SUNRISE BLVD, SUITE #102, PLANTATION, FL, 333134407, US | 6971 W SUNRISE BLVD, SUITE #102, PLANTATION, FL, 333134407, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-791-0711 |
| Fax | 9547914392 |
Authorized person
| Name | MRS. LIDIA E SERRANO |
| Role | CLINICAL DIRECTOR |
| Phone | 9547910711 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | HCC8589 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| License Number | HCC8589 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| License Number | HCC8589 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | HCC8589 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QS1000X - Student Health Clinic/Center |
| License Number | HCC8589 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001642200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Serrano, Lidia E | Agent | 6971 WEST SUNRISE BLVD., SUITE 102, PLANTATION, FL 33313 |
| Name | Role | Address |
|---|---|---|
| Serrano, Lidia E | Director | 6971 West Sunrise Blvd, suite 102 Plantation, FL 33313 |
| Name | Role | Address |
|---|---|---|
| Rivera, Timothy H, Sr. | Chief Operating Officer | 13500 SW 88th Street, 175 Miami, FL 33186 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000102752 | SOUTH FLORIDA FAMILY HEALTH & RESEARCH CENTERS | EXPIRED | 2009-04-30 | 2014-12-31 | No data | 6971 W. SUNRISE BLVD. 102, PLANTATION, FL, 33313 |
| G09064900414 | LSS HEALTH CARE CLINIC | EXPIRED | 2009-03-05 | 2014-12-31 | No data | 6971 W. SUNRISE BLVD. 102, PLANTATION, FL, 33313 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-07 | 13500 Southwest 88th Street, Suite 175, Miami, FL 33186 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-17 | 13500 Southwest 88th Street, Suite 175, Miami, FL 33186 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-01-11 | Serrano, Lidia E | No data |
| REINSTATEMENT | 2013-11-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REINSTATEMENT | 2010-09-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-05-03 | 6971 WEST SUNRISE BLVD., SUITE 102, PLANTATION, FL 33313 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-25 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-04-07 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-08 |
| ANNUAL REPORT | 2015-02-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
