| Entity Name: | FLAMINGO WOMEN'S PAVILION, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 14 Mar 2006 (19 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 26 Nov 2019 (5 years ago) |
| Document Number: | L06000027060 |
| FEI/EIN Number | 204495288 |
| Address: | 12600 PEMBROKE ROAD, 202, MIRAMAR, FL, 33027, US |
| Mail Address: | 12600 PEMBROKE ROAD, 202, MIRAMAR, FL, 33027, US |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881007938 | 2014-06-06 | 2014-06-06 | 12600 PEMBROKE RD, SUITE 202, MIRAMAR, FL, 330272544, US | 12600 PEMBROKE RD, SUITE 202, MIRAMAR, FL, 330272544, US | |||||||||||||||||||||||
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| Phone | +1 954-435-4700 |
Authorized person
| Name | MRS. JAQUELINE BENHJAMIN |
| Role | OFFICE MANAGER |
| Phone | 9544354700 |
Taxonomy
| Taxonomy Code | 332900000X - Non-Pharmacy Dispensing Site |
| License Number | ME 90059 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2745241 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BENJAMIN DWIGHT E | Agent | 12600 PEMBROKE ROAD, MIRAMAR, FL, 33027 |
| Name | Role | Address |
|---|---|---|
| BENJAMIN DWIGHT E | Manager | 12600 PEMBROKE ROAD, #202, PEMBROKE PINES, FL, 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2019-11-26 | BENJAMIN, DWIGHT EMD | No data |
| REINSTATEMENT | 2019-11-26 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-19 | 12600 PEMBROKE ROAD, 202, MIRAMAR, FL 33027 | No data |
| CHANGE OF MAILING ADDRESS | 2008-04-19 | 12600 PEMBROKE ROAD, 202, MIRAMAR, FL 33027 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-19 | 12600 PEMBROKE ROAD, SUITE 202, MIRAMAR, FL 33027 | No data |
| LC NAME CHANGE | 2006-05-22 | FLAMINGO WOMEN'S PAVILION, LLC | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-06-13 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-03-20 |
| REINSTATEMENT | 2019-11-26 |
| ANNUAL REPORT | 2018-03-27 |
| ANNUAL REPORT | 2017-07-02 |
| ANNUAL REPORT | 2016-01-23 |
| ANNUAL REPORT | 2015-01-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
