| Entity Name: | THE HEALTH CENTER OF COCONUT CREEK, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 15 Aug 2000 (24 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P00000077142 |
| FEI/EIN Number | 651032121 |
| Address: | 1784 W NORTHFIELD BLVD, #347, MURFREESBORO, TN, 37129, US |
| Mail Address: | 1784 W NORTHFIELD BLVD, #347, MURFREESBORO, TN, 37129, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457433864 | 2006-10-19 | 2010-02-25 | 4125 W. SAMPLE RD, COCONUT CREEK, FL, 33073, US | 4125 W. SAMPLE RD, COCONUT CREEK, FL, 33073, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-968-8333 |
| Fax | 9549686898 |
Authorized person
| Name | SHAWN P. CORLEY |
| Role | ADMINISTRATOR |
| Phone | 9549688333 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130470979 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022658100 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | L9C |
| Issuer | MEDICAID |
| Number | 02265100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| REGSITERED AGENTS INC. | Agent | 7901 4 ST N STE 300, ST PETERSBURG, FL, 33702 |
| Name | Role | Address |
|---|---|---|
| STRAWN STEVE | Director | 1784 W NORTHFIELD BLVD, MURFREESBORO, TN, 37129 |
| Name | Role | Address |
|---|---|---|
| STRAWN STEVE | President | 1784 W NORTHFIELD BLVD, MURFREESBORO, TN, 37129 |
| Name | Role | Address |
|---|---|---|
| STRAWN STEVE | Treasurer | 1784 W NORTHFIELD BLVD, MURFREESBORO, TN, 37129 |
| Name | Role | Address |
|---|---|---|
| STRAWN STEVE | Secretary | 1784 W NORTHFIELD BLVD, MURFREESBORO, TN, 37129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-04-17 | REGSITERED AGENTS INC. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-04-17 | 7901 4 ST N STE 300, ST PETERSBURG, FL 33702 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-09 | 1784 W NORTHFIELD BLVD, #347, MURFREESBORO, TN 37129 | No data |
| CHANGE OF MAILING ADDRESS | 2016-01-09 | 1784 W NORTHFIELD BLVD, #347, MURFREESBORO, TN 37129 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-04-18 |
| Reg. Agent Change | 2019-04-17 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-04-08 |
| ANNUAL REPORT | 2016-01-09 |
| ANNUAL REPORT | 2015-01-08 |
| ANNUAL REPORT | 2014-02-27 |
| ANNUAL REPORT | 2013-02-20 |
| ANNUAL REPORT | 2012-02-14 |
| ANNUAL REPORT | 2011-01-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
