| Entity Name: | SLP360, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 10 Sep 2014 (10 years ago) |
| Document Number: | N14000008448 |
| FEI/EIN Number | 47-1841433 |
| Address: | 2814 Lincoln Street, Hollywood, FL, 33020, US |
| Mail Address: | 2814 Lincoln Street, Hollywood, FL, 33020, US |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609100486 | 2009-09-25 | 2023-09-06 | 2814 LINCOLN ST, HOLLYWOOD, FL, 33020, US | 2814 LINCOLN ST, HOLLYWOOD, FL, 330203834, US | |||||||||||||||||||||||||||
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| Phone | +1 786-439-5550 |
| Fax | 8883358617 |
Authorized person
| Name | TIARA L COTTLE |
| Role | PRESIDENT |
| Phone | 7864395550 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 11982414 |
| State | FL |
| Issuer | MEDICAID |
| Number | 891202501 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COTTLE TIARA L | Agent | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| COTTLE TIARA L | President | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| CALDERON RAFAEL JR | Vice President | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| BURCHELL JAIYA S | AIDE | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Calderon Remi R | AIDE | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Name | Role | Address |
|---|---|---|
| Calderon IvyPearl | Aide | 2814 Lincoln Street, Hollywood, FL, 33020 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-06-30 | 2814 Lincoln Street, Hollywood, FL 33020 | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-30 | 2814 Lincoln Street, Hollywood, FL 33020 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-30 | 2814 Lincoln Street, Hollywood, FL 33020 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-13 |
| ANNUAL REPORT | 2023-09-03 |
| ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2021-05-05 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-04-30 |
| ANNUAL REPORT | 2015-04-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
