| Entity Name: | NORTH LAKE RETIREMENT HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Nov 1988 (36 years ago) |
| Document Number: | K47160 |
| FEI/EIN Number | 650092831 |
| Address: | 1222 N 16TH AVE, HOLLYWOOD, FL, 33020 |
| Mail Address: | 1222 N 16TH AVE, HOLLYWOOD, FL, 33020 |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417153446 | 2007-06-26 | 2007-10-01 | 1222 N 16TH AVE, HOLLYWOOD, FL, 330203741, US | 1222 N 16TH AVE, HOLLYWOOD, FL, 330203741, US | |||||||||||||||||
|
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| Phone | +1 954-922-2643 |
Authorized person
| Name | MR. PASCAL BERGERON |
| Role | ASST ADM |
| Phone | 9549222643 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7395 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BERGERON, GUY | Agent | 1222 N 16TH AVE, HOLLYWOOD, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| Bergeron Guy | Director | 1222 N. 16TH AVE., HOLLYWOOD, FL, 33020 |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J14000550557 | TERMINATED | 1000000611910 | BROWARD | 2014-04-18 | 2024-05-01 | $ 9,254.67 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J13000841214 | TERMINATED | 1000000378740 | BROWARD | 2013-04-29 | 2023-05-03 | $ 7,576.22 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J13000871542 | TERMINATED | 1000000497892 | BROWARD | 2013-04-29 | 2033-05-03 | $ 330.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J13000871559 | TERMINATED | 1000000497893 | BROWARD | 2013-04-29 | 2023-05-03 | $ 7,827.92 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3301 N UNIVERSITY DR STE 200, CORAL SPRINGS FL330654149 |
| J11000768734 | TERMINATED | 1000000240373 | BROWARD | 2011-11-10 | 2021-11-23 | $ 12,479.34 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, CORAL SPRINGS SERVICE CENTER, 3111 N UNIVERSITY DR STE 501, CORAL SPRINGS FL330655096 |
| J07000341670 | LAPSED | 04-06669 COWE 80 | BROWARD COUNTY COURT | 2006-06-08 | 2012-10-19 | $2007.46 | JUAN G. ANDREU ESQ., 701 SW 27 AVE, SUITE 900, MIAMI, FL 33135 |
| J02000126262 | LAPSED | 00-10050-BKC-RAM | US BNKRTCY CT SOUTHERN DIS MIA | 2002-03-18 | 2007-04-08 | $16,071.54 | JOEL L TABAS AS TRUSTEE FOR FLAGSHIP PHARM, 25 S E 2ND AVENUE SUITE 919, MIAMI FL 33131 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
