| Entity Name: | THE DIABETIC PLACE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 23 Apr 2007 (18 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 02 Sep 2008 (16 years ago) |
| Document Number: | L07000043100 |
| FEI/EIN Number | 331167682 |
| Address: | 10081 Pines Blvd, Pembroke Pines, FL, 33026, US |
| Mail Address: | 1321 sw 103 ave, PEMBROKE PINES, FL, 33025, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104022169 | 2007-06-26 | 2015-03-30 | PO BOX 848182, HOLLYWOOD, FL, 330840182, US | 10472 TAFT ST, PEMBROKE PINES, FL, 330262819, US | |||||||||||||||||||||||||
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| Phone | +1 954-990-0461 |
| Fax | 9549900465 |
Authorized person
| Name | DR. SHAWNA CHARLES |
| Role | NURSE PRACTITIONER |
| Phone | 9549900461 |
Taxonomy
| Taxonomy Code | 363LF0000X - Family Nurse Practitioner |
| License Number | 1956772 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 281108100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHARLES S V | Agent | 1321 sw 103 ave, PEMBROKE PINES, FL, 33025 |
| Name | Role | Address |
|---|---|---|
| CHARLES S V | Managing Member | 1321 sw 103 ave, PEMBROKE PINES, FL, 33025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-28 | 10081 Pines Blvd, Suite D, Pembroke Pines, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-28 | 10081 Pines Blvd, Suite D, Pembroke Pines, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-28 | 1321 sw 103 ave, PEMBROKE PINES, FL 33025 | No data |
| LC VOLUNTARY DISSOLUTION | 2008-09-02 | No data | No data |
| LC AMENDMENT | 2008-09-02 | No data | No data |
| LC AMENDMENT | 2007-06-11 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-03-27 |
| ANNUAL REPORT | 2022-01-19 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-03-28 |
| ANNUAL REPORT | 2019-04-13 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-04-23 |
| ANNUAL REPORT | 2015-04-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
