| Entity Name: | MEDICAL REHAB CLINIC OF BROWARD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 17 Mar 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 Oct 2023 (a year ago) |
| Document Number: | L05000027365 |
| FEI/EIN Number | 202545768 |
| Address: | 1528 NE 4TH AVE, FT LAUDERDALE, FL, 33304 |
| Mail Address: | 1528 NE 4TH AVENUE, FORT LAUDERDALE, FL, 33304 |
| ZIP code: | 33304 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891703351 | 2006-08-03 | 2012-11-19 | 1528 NE 4TH AVE, FORT LAUDERDALE, FL, 333041036, US | 1528 NE 4TH AVE, FORT LAUDERDALE, FL, 333041036, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 954-467-8855 |
| Fax | 9544678857 |
Authorized person
| Name | CHARLES HARRY RICHARD |
| Role | MEDICAL DIRECTOR |
| Phone | 9544678855 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | OS8590 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001414000 |
| State | FL |
| Issuer | MEDICARE PTAN |
| Number | U2206X |
| Name | Role | Address |
|---|---|---|
| RICHARD DR. CHARLES H | Agent | 1528 NE 4TH AVE, FT LAUDERDALE, FL, 33304 |
| Name | Role | Address |
|---|---|---|
| RICHARD CHARLES H | Manager | 1528 NE 4TH AVE, FT LAUDERDALE, FL, 33304 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-10-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REINSTATEMENT | 2018-04-23 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-19 | RICHARD, DR. CHARLES H | No data |
| REINSTATEMENT | 2016-10-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2012-05-04 | 1528 NE 4TH AVE, FT LAUDERDALE, FL 33304 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-05-04 | 1528 NE 4TH AVE, FT LAUDERDALE, FL 33304 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-05-04 | 1528 NE 4TH AVE, FT LAUDERDALE, FL 33304 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| REINSTATEMENT | 2023-10-20 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-04-18 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-30 |
| REINSTATEMENT | 2018-04-23 |
| REINSTATEMENT | 2016-10-19 |
| ANNUAL REPORT | 2015-02-14 |
| ANNUAL REPORT | 2014-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
