| Entity Name: | CROCKETT FOUNDATION INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 15 Apr 2005 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 20 Jan 2015 (10 years ago) |
| Document Number: | N05000003896 |
| FEI/EIN Number | 202689974 |
| Address: | 5101 NW 21ST AVE, Fort Lauderdale, FL, 33309, US |
| Mail Address: | 5101 NW 21ST AVE, Fort Lauderdale, FL, 33309, US |
| ZIP code: | 33309 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184295123 | 2021-07-09 | 2021-07-09 | 401 SW 1ST AVE STE 102, FORT LAUDERDALE, FL, 333012853, US | 401 SW 1ST AVE STE 102, FORT LAUDERDALE, FL, 333012853, US | |||||||||||||
|
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| Phone | +1 754-666-3928 |
Authorized person
| Name | MS. REGINE KANZKI |
| Role | VICE PRESIDENT OF OPERATIONS |
| Phone | 9548229370 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Henri Crockett | Agent | 5101 NW 21st ave, Fort Lauderdale, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| CROCKETT ZACHARY | Vice President | 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| CROCKETT ZACHARY | Director | 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024 |
| KEVIN PROPHETE | Director | 3000 NE 188TH ST UNIT 605, AVENTURA, FL, 33180 |
| STOCKER MICHELE | Director | 3000 NE 188TH ST UNIT 605, AVENTURA, FL, 33180 |
| Biard Benjamin | Director | 3129 NW 82nd Terr, Cooper City, FL, 33024 |
| CROCKETT HENRI | Director | 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| Munoz Eric | Treasurer | 3129 NW 82nd Terr, Cooper City, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| CROCKETT HENRI | President | 3129 NW 82ND TERRACE, COOPER CITY, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2022-01-24 | 5101 NW 21st ave, 530, Fort Lauderdale, FL 33309 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-01-15 | 5101 NW 21ST AVE, STE 530, Fort Lauderdale, FL 33309 | No data |
| CHANGE OF MAILING ADDRESS | 2020-01-15 | 5101 NW 21ST AVE, STE 530, Fort Lauderdale, FL 33309 | No data |
| REINSTATEMENT | 2015-01-20 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-01-20 | Henri Crockett | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2013-03-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-01-24 |
| AMENDED ANNUAL REPORT | 2021-06-01 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-22 |
| ANNUAL REPORT | 2017-05-02 |
| ANNUAL REPORT | 2016-04-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
