| Entity Name: | WOMEN & TEENS HEALTHCARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Sep 2000 (24 years ago) |
| Document Number: | P00000090692 |
| FEI/EIN Number | 651044772 |
| Address: | 16876 N.E. 19TH AVE., N MIAMI BEACH, FL, 33162 |
| Mail Address: | 16876 N.E. 19TH AVE., N MIAMI BEACH, FL, 33162 |
| ZIP code: | 33162 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083982649 | 2011-12-09 | 2016-05-24 | 16876 NE 19TH AVE, NORTH MIAMI BEACH, FL, 331623108, US | 16876 NE 19TH AVE, NORTH MIAMI BEACH, FL, 331623108, US | |||||||||||||||||||||||||
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| Phone | +1 305-895-5555 |
| Fax | 3059470061 |
Authorized person
| Name | DR. SYLVESTER BRAITHWAITE |
| Role | MD |
| Phone | 3058955555 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME062140 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275868700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Braithwaite Sylvester RDr. | Agent | 16876 N.E. 19TH AVE., N MIAMI BEACH, FL, 33162 |
| Name | Role | Address |
|---|---|---|
| BRAITHWAITE SYLVESTER D | President | 16876 N.E. 19TH AVE., NO. MIAMI BEACH, FL, 33162 |
| Name | Role | Address |
|---|---|---|
| BRAITHWAITE SYLVESTER D | Chief Executive Officer | 16876 N.E. 19TH AVE., NO. MIAMI BEACH, FL, 33162 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000007005 | WOMEN & TEENS HEALTHCARE, INC | ACTIVE | 2012-01-19 | 2027-12-31 | No data | 16876 NE 19TH AVE, NORTH MIAMI BEACH, FL, 33162 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-09-27 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| NAME CHANGE AMENDMENT | 2012-01-27 | WOMEN & TEENS HEALTHCARE, INC. | No data |
| NAME CHANGE AMENDMENT | 2000-10-06 | WOMEN & TEENS COMMUNITY HEALTHCARE CENTER, INC. | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
