| Entity Name: | BREEN HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Sep 2012 (12 years ago) |
| Document Number: | L12000122627 |
| FEI/EIN Number | 46-1055799 |
| Address: | 11392 E Highway 316, Ft Mccoy, FL, 32134, US |
| Mail Address: | 11392 E Highway 316, Ft Mccoy, FL, 32134, US |
| ZIP code: | 32134 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144666439 | 2013-05-14 | 2020-02-04 | 11392 NE HIGHWAY 316, FORT MCCOY, FL, 321348114, US | 11392 NE HIGHWAY 316, FORT MCCOY, FL, 321340000, US | |||||||||||||||||||||||||
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| Phone | +1 352-236-0440 |
| Fax | 3522360717 |
Authorized person
| Name | SONDRA SMITH |
| Role | PRESIDENT/OWNER |
| Phone | 7864098387 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR1300X - Rural Health Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PTAN |
| Number | 683830 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Smith Sondra LAPRN | Agent | 11392 E Highway 316, Ft Mccoy, FL, 32134 |
| Name | Role | Address |
|---|---|---|
| Smith Sondra L | Auth | 11392 E Highway 316, Ft Mccoy, FL, 32134 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000049642 | COMMUNITY FAMILY HEALTH CARE | ACTIVE | 2020-05-05 | 2025-12-31 | No data | 11392 E HIGHWAY 316, FORT MCCOY, FL, 32134 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-02 | 11392 E Highway 316, Ft Mccoy, FL 32134 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-02 | 11392 E Highway 316, Ft Mccoy, FL 32134 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-01-02 | Smith, Sondra L, APRN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-02 | 11392 E Highway 316, Ft Mccoy, FL 32134 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J19000413656 | TERMINATED | 1000000829892 | MARION | 2019-06-10 | 2029-06-12 | $ 1,299.35 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ALACHUA SERVICE CENTER, 14107 NW US HWY 441 STE 100, ALACHUA FL326156390 |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-11-27 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-01-18 |
| ANNUAL REPORT | 2022-04-05 |
| ANNUAL REPORT | 2021-04-02 |
| ANNUAL REPORT | 2020-01-02 |
| ANNUAL REPORT | 2019-04-01 |
| ANNUAL REPORT | 2018-01-02 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
