| Entity Name: | PEDIATRIC CENTER FOR EXCELLENCE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Dec 2016 (8 years ago) |
| Date of dissolution: | 01 Apr 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 01 Apr 2022 (3 years ago) |
| Document Number: | L16000228721 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 4160 Boulevard Center Drive, Jacksonville, FL, 32207, US |
| Mail Address: | 4160 Boulevard Center Drive, Jacksonville, FL, 32207, US |
| ZIP code: | 32207 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215434980 | 2018-04-10 | 2018-04-10 | 13241 BARTRAM PARK BLVD UNIT 209, JACKSONVILLE, FL, 322585233, US | 13241 BARTRAM PARK BLVD UNIT 209, JACKSONVILLE, FL, 322585233, US | |||||||||||||||||||||||
|
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| Phone | +1 904-224-5437 |
| Fax | 9046742313 |
Authorized person
| Name | ASHRAF A AFFAN |
| Role | OWNER |
| Phone | 9042245437 |
Taxonomy
| Taxonomy Code | 2251P0200X - Pediatric Physical Therapist |
| Is Primary | Yes |
| Taxonomy Code | 225XP0200X - Pediatric Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| Affan Ashraf | Agent | 4160 Boulevard Center Drive, Jacksonville, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| AFFAN ASHRAF M.D. | Manager | 4160 Boulevard Center Drive, Jacksonville, FL, 32207 |
| GHANDOUR AZZA | Manager | 4160 Boulevard Center Drive, Jacksonville, FL, 32207 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-01 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2021-05-27 | Affan, Ashraf | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-05-27 | 4160 Boulevard Center Drive, Jacksonville, FL 32207 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-04-30 | 4160 Boulevard Center Drive, Jacksonville, FL 32207 | No data |
| CHANGE OF MAILING ADDRESS | 2020-04-30 | 4160 Boulevard Center Drive, Jacksonville, FL 32207 | No data |
| LC AMENDMENT AND NAME CHANGE | 2018-03-21 | PEDIATRIC CENTER FOR EXCELLENCE, LLC | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-01 |
| AMENDED ANNUAL REPORT | 2021-05-27 |
| ANNUAL REPORT | 2021-03-25 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-03-24 |
| LC Amendment and Name Change | 2018-03-21 |
| ANNUAL REPORT | 2017-04-02 |
| Florida Limited Liability | 2016-12-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
