| Entity Name: | NORTHWEST FAMILY HEALTH CENTER, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 16 May 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 04 Oct 2022 (2 years ago) |
| Document Number: | L16000095054 |
| FEI/EIN Number | 81-2625429 |
| Address: | 5844 North Orange Blossom Trail, Orlando, FL 32810 |
| Mail Address: | PO BOX 951306, Lake Mary, FL 32795 |
| ZIP code: | 32810 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1750838041 | 2016-09-06 | 2020-10-16 | PO BOX 951306, LAKE MARY, FL, 327951306, US | 5844 N ORANGE BLOSSOM TRL, ORLANDO, FL, 328101025, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 407-602-1100 |
| Fax | 4072194221 |
Authorized person
| Name | DR. GARRY B ANTOINE |
| Role | PRESIDENT & CEO |
| Phone | 4077685773 |
Taxonomy
| Taxonomy Code | 163WC0200X - Critical Care Medicine Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 163WE0003X - Emergency Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME128359 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ACN675 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 2279C0205X - Critical Care Registered Respiratory Therapist |
| Is Primary | No |
| Taxonomy Code | 2279E0002X - Emergency Care Registered Respiratory Therapist |
| Is Primary | No |
| Taxonomy Code | 261QU0200X - Urgent Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 3336C0002X - Clinic Pharmacy |
| Is Primary | No |
| Taxonomy Code | 363L00000X - Nurse Practitioner |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015253600 |
| State | FL |
| Issuer | MEDICAID |
| Number | 101655000 |
| State | FL |
| Issuer | MEDICAID |
| Number | 01955724 |
| State | NY |
| Name | Role | Address |
|---|---|---|
| ANTOINE, GARRY BEAUBRUN, MD, RRT | Agent | 5844 North Orange Blossom Trail, Orlando, FL 32810 |
| Name | Role | Address |
|---|---|---|
| ANTOINE, MD, RRT, GARRY B., Dr. | Manager | 5844 North Orange Blossom Trail, Orlando, FL 32810 |
| Name | Role | Address |
|---|---|---|
| ANTOINE, MD, RRT, GARRY B., Dr. | Registered Agent | 5844 North Orange Blossom Trail, Orlando, FL 32810 |
| Name | Role | Address |
|---|---|---|
| ANTOINE, MD, RRT, GARRY B., Dr. | RA | 5844 North Orange Blossom Trail, Orlando, FL 32810 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000031809 | NORTHWEST FAMILY HEALTH CENTER | ACTIVE | 2023-03-08 | 2028-12-31 | No data | 1630 MASON AVENUE, SUITE B, DAYTONA BEACH, FL, 32117 |
| G20000058349 | NORTHWEST URGENT CARE | ACTIVE | 2020-05-26 | 2025-12-31 | No data | PO BOX 951306, LAKE MARY, FL, 32795 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-10-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-07-27 | ANTOINE, GARRY BEAUBRUN, MD, RRT | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-07-27 | 5844 North Orange Blossom Trail, Orlando, FL 32810 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-28 | 5844 North Orange Blossom Trail, Orlando, FL 32810 | No data |
| REINSTATEMENT | 2019-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-10-01 | 5844 North Orange Blossom Trail, Orlando, FL 32810 | No data |
| REINSTATEMENT | 2018-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-01 |
| ANNUAL REPORT | 2023-02-16 |
| AMENDED ANNUAL REPORT | 2022-12-05 |
| REINSTATEMENT | 2022-10-04 |
| ANNUAL REPORT | 2021-07-27 |
| ANNUAL REPORT | 2020-06-28 |
| REINSTATEMENT | 2019-10-01 |
| REINSTATEMENT | 2018-10-01 |
| REINSTATEMENT | 2017-10-26 |
| LC Amendment | 2016-09-19 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 5403348910 | 2021-04-30 | 0491 | PPS | 5844 N Orange Blossom Trl, Orlando, FL, 32810-1025 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4753817701 | 2020-05-01 | 0491 | PPP | 5844 NORTH ORANGE BLOSSOM TRAIL, ORLANDO, FL, 32810 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 19 Feb 2025
Sources: Florida Department of State
