| Entity Name: | EL-SHADDAI ELOHIM MEDICAL CENTER LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Apr 2021 (4 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 15 Nov 2021 (3 years ago) |
| Document Number: | L21000155670 |
| FEI/EIN Number | 85-2091469 |
| Address: | 10000 Stirling Rd, 12, Cooper City, FL 33024 |
| Mail Address: | 15635 SW 52ND CT, MIRAMAR, FL 33027 |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730808940 | 2022-08-23 | 2024-09-06 | 15635 SW 52ND CT, MIRAMAR, FL, 330274982, US | 10000 STIRLING RD STE 12, HOLLYWOOD, FL, 330248067, US | |||||||||||||||
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| Phone | +1 954-815-7268 |
| Fax | 9545057943 |
Authorized person
| Name | DR. SHERLY M BOULAY |
| Role | PRESIDENT |
| Phone | 9548157268 |
Taxonomy
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BOULAY, SHERLY, DR | Agent | 15635 SW 52ND CT, MIRAMAR, FL 33027 |
| Name | Role | Address |
|---|---|---|
| BOULAY, SHERLY | Manager | 15635 SW 52ND CT, MIRAMAR, FL 33027 |
| BOULAY, JEAN M. | Manager | 15635 SW 52ND CT, HOLLYWOOD, FL 33027 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-01-06 | 10000 Stirling Rd, 12, Cooper City, FL 33024 | No data |
| LC AMENDMENT | 2021-11-15 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-06 |
| LC Amendment | 2021-11-15 |
| Florida Limited Liability | 2021-04-05 |
Date of last update: 13 Feb 2025
Sources: Florida Department of State
