| Entity Name: | TEN BROECK JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
TEN BROECK JACKSONVILLE, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 06 Apr 1999 (26 years ago) |
| Date of dissolution: | 24 Apr 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 24 Apr 2018 (7 years ago) |
| Document Number: | L99000002041 |
| FEI/EIN Number |
593568978
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| Mail Address: | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| ZIP code: | 34786 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497758312 | 2005-05-24 | 2008-05-08 | 6300 BEACH BLVD, JACKSONVILLE, FL, 322162708, US | 6300 BEACH BLVD, JACKSONVILLE, FL, 322162708, US | |||||||||||||||||||||||||
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| Phone | +1 904-724-9202 |
| Fax | 9047243797 |
Authorized person
| Name | MR. DAVID CORDDRY |
| Role | VICE PRESIDENT OF FINANCE |
| Phone | 4078762200 |
Taxonomy
| Taxonomy Code | 283Q00000X - Psychiatric Hospital |
| License Number | 4011 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075144816 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DIZNEY DONALD R | CAS | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| DIZNEY DAVID A | President | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| DIZNEY DAVID A | Chief Executive Officer | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| BARKMAN KEVIN | Executive Vice President | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| BARKMAN KEVIN | Secretary | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| CORDDRY DAVID | Vice President | 603 MAIN STREET, WINDERMERE, FL, 34786 |
| BARKMAN KEVIN | Agent | 603 MAIN STREET, WINDERMERE, FL, 347861100 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-04-24 | - | - |
| CHANGE OF MAILING ADDRESS | 2009-02-16 | 603 MAIN STREET, WINDERMERE, FL 34786 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2001-05-03 | 603 MAIN STREET, WINDERMERE, FL 34786-1100 | - |
| REGISTERED AGENT NAME CHANGED | 2000-08-16 | BARKMAN, KEVIN | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-02-16 |
| ANNUAL REPORT | 2015-02-16 |
| ANNUAL REPORT | 2014-01-09 |
| ANNUAL REPORT | 2013-04-17 |
| ANNUAL REPORT | 2012-02-27 |
| ANNUAL REPORT | 2011-03-02 |
| ANNUAL REPORT | 2010-03-09 |
| ANNUAL REPORT | 2009-02-16 |
| ANNUAL REPORT | 2008-05-27 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
