| Entity Name: | FOUNDATION MEDICAL CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 28 Sep 2017 (7 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L17000201355 |
| FEI/EIN Number | 822928898 |
| Mail Address: | 10790 Haydn Drive, Boca Raton, FL, 33498, US |
| Address: | 10790 Haydn Drive, SUITE 101, Boca Raton, FL, 33498, US |
| ZIP code: | 33498 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124538996 | 2017-10-06 | 2019-11-17 | 3000 NW 101ST LN STE 101, CORAL SPRINGS, FL, 330653930, US | 3000 NW 101ST LN STE 101, CORAL SPRINGS, FL, 33065, US | |||||||||||||||||||||||||||
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| Phone | +1 954-272-4072 |
| Fax | 9542559553 |
| Phone | +1 561-674-2696 |
| Fax | 5613707899 |
Authorized person
| Name | MR. EVAN M KAISER |
| Role | MANAGER |
| Phone | 9542724072 |
Taxonomy
| Taxonomy Code | 261QH0100X - Health Service Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0850X - Adult Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0405X - Substance Use Disorder Rehabilitation Clinic/Center |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Prisco Salvatore | Agent | 10790 Haydn Drive, Boca Raton, FL, 33498 |
| Name | Role | Address |
|---|---|---|
| Prisco Jude | Manager | 10790 Haydn Drive, Boca Raton, FL, 33498 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-12 | 10790 Haydn Drive, SUITE 101, Boca Raton, FL 33498 | No data |
| CHANGE OF MAILING ADDRESS | 2021-01-12 | 10790 Haydn Drive, SUITE 101, Boca Raton, FL 33498 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-12 | Prisco, Salvatore | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-12 | 10790 Haydn Drive, Boca Raton, FL 33498 | No data |
| LC AMENDMENT | 2020-07-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-09-18 |
| LC Amendment | 2020-07-21 |
| ANNUAL REPORT | 2019-01-30 |
| ANNUAL REPORT | 2018-03-21 |
| Florida Limited Liability | 2017-09-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
