| Entity Name: | EMERALD HILLS REHABILITATION CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 14 Apr 1978 (47 years ago) |
| Date of dissolution: | 30 Dec 2014 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 30 Dec 2014 (10 years ago) |
| Document Number: | 568579 |
| FEI/EIN Number | 59-1815845 |
| Mail Address: | 179 CHUNILOTI WAY, LOUDON, TN 37774 |
| Address: | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021-3634 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1922107820 | 2006-09-21 | 2013-01-08 | 3850 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US | 3850 SHERIDAN STREET, HOLLYWOOD, FL, 33021, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-989-5255 |
| Fax | 9549626445 |
Authorized person
| Name | DR. CHARLES MICHAEL SHAPIRO |
| Role | PRESIDENT |
| Phone | 9549895255 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT2021 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT19559 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT22241 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT32161 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | UNITED HEALTHCARE |
| Number | 1131310 |
| State | FL |
| Issuer | AVMED |
| Number | 228790 |
| State | FL |
| Issuer | US DEPARTAMENT OF LABOR |
| Number | 372531000 |
| State | FL |
| Issuer | AETNA HMO |
| Number | 2072908 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | K1489 |
| State | FL |
| Issuer | AETNA PPO |
| Number | 4565667 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | Y914R |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, CHARLES MPRES. | Agent | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, CHARLES MP | President | 179 CHUNILOTI WAY, LOUDON, TN 37774 |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, ANNA BST | Secretary | 3811 THOMAS STREET, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, ANNA BST | Treasurer | 3811 THOMAS STREET, HOLLYWOOD, FL 33021 |
| Name | Role | Address |
|---|---|---|
| SHAPIRO, KAREN SV | Vice President | 179 CHUNILOTI WAY, LOUDON, TN 37774 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-30 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-12 | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021-3634 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-04-19 | SHAPIRO, CHARLES MPRES. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2001-05-11 | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021-3634 | No data |
| REINSTATEMENT | 1989-10-30 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1989-10-13 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 1985-06-11 | 3850 SHERIDAN STREET, HOLLYWOOD, FL 33021 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2014-12-30 |
| ANNUAL REPORT | 2014-04-28 |
| ANNUAL REPORT | 2013-02-12 |
| ANNUAL REPORT | 2012-02-29 |
| ANNUAL REPORT | 2011-01-12 |
| ANNUAL REPORT | 2010-01-19 |
| ANNUAL REPORT | 2009-01-14 |
| ANNUAL REPORT | 2008-01-23 |
| ANNUAL REPORT | 2007-05-04 |
| ANNUAL REPORT | 2006-04-18 |
Date of last update: 05 Feb 2025
Sources: Florida Department of State
