| Entity Name: | DAN BLACK ENTERPRISES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 05 Jan 2000 (25 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P00000003484 |
| FEI/EIN Number | 650972214 |
| Address: | 6030 NW 42ND AVE, COCONUT CREEK, FL, 33073 |
| Mail Address: | 6030 NW 42ND AVE, COCONUT CREEK, FL, 33073 |
| ZIP code: | 33073 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104116870 | 2011-04-14 | 2016-06-02 | 6030 NW 42ND AVE, COCONUT CREEK, FL, 330733272, US | 6030 NW 42ND AVE, COCONUT CREEK, FL, 330733272, US | |||||||||||||||||||||||||
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| Phone | +1 954-290-9282 |
| Fax | 5618532195 |
Authorized person
| Name | MR. DANIEL SPENCER BLACK |
| Role | PRESIDENT |
| Phone | 9542909282 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 0833 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 676044996 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLACK DANIEL | Agent | 6030 NW 42ND AVE, COCONUT CREEK, FL, 33073 |
| Name | Role | Address |
|---|---|---|
| BLACK DANIEL | President | 6030 NW 42ND AVE, COCONUT CREEK, FL, 33073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-01-04 | 6030 NW 42ND AVE, COCONUT CREEK, FL 33073 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-12-01 | 6030 NW 42ND AVE, COCONUT CREEK, FL 33073 | No data |
| CHANGE OF MAILING ADDRESS | 2004-12-01 | 6030 NW 42ND AVE, COCONUT CREEK, FL 33073 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-01-21 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-04-12 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-01-14 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-02-12 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
