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  5. HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.

HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.

Company Details

Entity Name: HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive
Date Filed: 10 Nov 1970 (54 years ago)
Document Number: 719670
FEI/EIN Number 591481561
Address: 5727 NW 17th Avenue, MIAMI, FL, 33142, US
Mail Address: 5727 NW 17th Avenue, MIAMI, FL, 33142, US
ZIP code: 33142
County: Miami-Dade
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1982706347 2006-09-05 2020-08-22 3090 S DOUGLAS RD, MIAMI, FL, 331334311, US 3090 S DOUGLAS RD, MIAMI, FL, 331334311, US

Contacts
Phone +1 305-351-1362
Fax 3053511297

Authorized person
Name DR. SAMUEL K. JAMES
Role PHARMACY DIRECTOR
Phone 3053511362

Taxonomy
Taxonomy Code 261QF0400X - Federally Qualified Health Center (FQHC)
License Number PH18014
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2015 591481561 2016-01-27 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 55
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 624200
Sponsor’s telephone number 3059926495
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2016-01-27
Name of individual signing N.PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2014 591481561 2015-07-31 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 60
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 624200
Sponsor’s telephone number 3059926495
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-06-09
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2013 591481561 2015-02-18 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 624200
Sponsor’s telephone number 3054474950
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-01-26
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2012 591481561 2015-02-18 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 624200
Sponsor’s telephone number 3054474950
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-01-26
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2011 591481561 2015-02-18 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 63
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Business code 624200
Sponsor’s telephone number 3054474950
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Plan administrator’s name and address
Administrator’s EIN 591481561
Plan administrator’s name HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Plan administrator’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-01-26
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2011 591481561 2015-02-18 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 63
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Sponsor’s telephone number 3054474950
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Plan administrator’s name and address
Administrator’s EIN 591481561
Plan administrator’s name HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Plan administrator’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-01-26
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature
HELEN B. BENTLEY FAMILY HEALTH CENTER 403(B) PLAN 2011 591481561 2015-02-18 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. 63
Three-digit plan number (PN) 001
Effective date of plan 1989-01-01
Sponsor’s telephone number 3054474950
Plan sponsor’s address P. O. BOX 330868, MIAMI, FL, 332330868

Plan administrator’s name and address
Administrator’s EIN 591481561
Plan administrator’s name HELEN B. BENTLEY FAMILY HEALTH CENTER, INC.
Plan administrator’s address P. O. BOX 330868, MIAMI, FL, 332330868

Signature of
Role Plan administrator
Date 2015-01-26
Name of individual signing N. PATRICK RANGE JR.
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
RANGE NORMAN P Agent 5727 NW 17th Avenue, MIAMI, FL, 33142

Chairman

Name Role Address
RANGE Norman P Chairman 5727 N.W. 17th Avenue, MIAMI, FL, 33142

Director

Name Role Address
RANGE Norman P Director 5727 N.W. 17th Avenue, MIAMI, FL, 33142
JAMES-FOUNTAIN ZONDRA Director 10393 SW 153rd Street, Miami, FL, 33157
TINNIE GENE S Director 74 N.W. 51st Street, MIAMI, FL, 33127
JORDAN BARBARA B Director 22804 SW 105th Avenue, Cutler Bay, FL, 33190

Treasurer

Name Role Address
JAMES-FOUNTAIN ZONDRA Treasurer 10393 SW 153rd Street, Miami, FL, 33157

Vice Chairman

Name Role Address
TINNIE GENE S Vice Chairman 74 N.W. 51st Street, MIAMI, FL, 33127

Secretary

Name Role Address
JORDAN BARBARA B Secretary 22804 SW 105th Avenue, Cutler Bay, FL, 33190

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2016-05-12 No data No data
REINSTATEMENT 2016-03-18 No data No data
ADMIN DISSOLUTION FOR ANNUAL REPORT 2014-09-26 No data No data
AMENDMENT 2005-10-06 No data No data
NAME CHANGE AMENDMENT 1996-10-28 HELEN B. BENTLEY FAMILY HEALTH CENTER, INC. No data
NAME CHANGE AMENDMENT 1986-04-07 COCONUT GROVE FAMILY HEALTH CENTER, INC . No data

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J13001340034 TERMINATED 1000000520241 DADE 2013-08-13 2023-09-05 $ 25,968.25 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SERVICE CENTER, 8175 NW 12TH ST STE 119, DORAL FL331261828
J11000529953 TERMINATED 1000000229003 DADE 2011-08-10 2021-08-17 $ 2,881.75 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SOUTH SERVICE CENTER, 8175 NW 12TH ST STE 418, MIAMI FL331261828
J11000407010 TERMINATED 1000000221076 DADE 2011-06-22 2021-06-29 $ 13,335.47 STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI SOUTH SERVICE CENTER, 8175 NW 12TH ST STE 418, MIAMI FL331261828

Related by officers

TINNIE GENE S

ASALH SOUTH FLORIDA, INC. SOUTH FLORIDA COMMUNITY PARTNERS, INC. AFRICAN-AMERICAN CARIBBEAN CULTURAL ARTS COMMISSION, INCORPORATED

RANGE NORMAN P

FRIENDS OF HISTORIC VIRGINIA BEACH PARK AND MUSEUM

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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