| Entity Name: | GOAL PSYCHIATRIC ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 14 Jul 2011 (14 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L11000081523 |
| FEI/EIN Number | 452915415 |
| Address: | 1040 WESTON ROAD, STE 210, WESTON, FL, 33326 |
| Mail Address: | 1040 WESTON ROAD, STE 210, WESTON, FL, 33326 |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427338680 | 2011-08-19 | 2014-01-13 | 1040 WESTON RD, SUITE 210, WESTON, FL, 333261912, US | 1040 WESTON RD, SUITE 210, WESTON, FL, 333261912, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-766-4702 |
| Fax | 9547664907 |
Authorized person
| Name | DR. EDWIN A GOMEZ |
| Role | OWNER |
| Phone | 9547664702 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| License Number | ME97741 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 2084P0804X - Child & Adolescent Psychiatry Physician |
| License Number | ME97741 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001441900 |
| State | FL |
| Issuer | GROUP MEDICARE PTAN |
| Number | GM814A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOMEZ EDWIN A | Agent | 1040 WESTON ROAD, WESTON, FL, 33326 |
| Name | Role | Address |
|---|---|---|
| GOMEZ EDWIN A | Managing Member | 1040 WESTON ROAD, WESTON, FL, 33326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CONVERSION | 2011-07-14 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P11000022500. CONVERSION NUMBER 900000115129 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-03-06 |
| ANNUAL REPORT | 2014-04-08 |
| ANNUAL REPORT | 2013-05-01 |
| ANNUAL REPORT | 2012-04-27 |
| Florida Limited Liability | 2011-07-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
