| Entity Name: | GREENLIFE INTENSIVE OUTPATIENT PROGRAM, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 09 Jul 2012 (13 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 01 Feb 2016 (9 years ago) |
| Document Number: | L12000088610 |
| FEI/EIN Number | 46-0525989 |
| Address: | 1601 N PALM AVENUE, PEMBROKE PINES, FL, 33026, US |
| Mail Address: | 1601 N PALM AVENUE, PEMBROKE PINES, FL, 33026, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1740638717 | 2016-05-31 | 2016-05-31 | 282 NW 162ND AVE, PEMBROKE PINES, FL, 330281147, US | 1601 N PALM AVE, SUITE 106, PEMBROKE PINES, FL, 330263200, US | |||||||||||||||
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| Phone | +1 954-854-9053 |
Authorized person
| Name | NICOLA RAJARAM |
| Role | BILLING MANAGER |
| Phone | 9542726723 |
Taxonomy
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| ITZCHAKI ZVI | Agent | 1601 N PALM AVE, PEMBROKE PINES, FL, 33026 |
| Name | Role | Address |
|---|---|---|
| ITZCHAKI ZVI | Manager | 1601 N PALM AVE, PEMBROKE PINES, FL, 33026 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000124398 | GREENLIFE I.O.P., LLC | EXPIRED | 2012-12-23 | 2017-12-31 | No data | 282 N W 162ND AVENUE, PEMBROKE PINES, FL, 33028 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-09 | 1601 N PALM AVENUE, SUITE 210, PEMBROKE PINES, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-09 | 1601 N PALM AVENUE, SUITE 210, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-09 | 1601 N PALM AVE, SUITE 210, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-11-20 | ITZCHAKI, ZVI | No data |
| LC AMENDMENT | 2016-02-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-01-28 |
| ANNUAL REPORT | 2021-01-28 |
| AMENDED ANNUAL REPORT | 2020-11-20 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-12 |
| ANNUAL REPORT | 2017-02-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
