| Entity Name: | MEDI-NURSE BEHAVIORAL SOLUTIONS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Jan 2002 (23 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | P02000010490 |
| FEI/EIN Number | 043594205 |
| Address: | 2800 W OAKLAND PARK BLVD, SUITE 206, FT LAUDERDALE, FL, 33311 |
| Mail Address: | 6175 NW 167TH ST., G-15, MIAMI, FL, 33015 |
| ZIP code: | 33311 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336199447 | 2006-05-11 | 2022-07-21 | 2800 W OAKLAND PARK BLVD, SUITE 206, OAKLAND PARK, FL, 333111370, US | 6175 NW 167TH ST, SUITE G-15, MIAMI, FL, 330154339, US | |||||||||||||||||||||||||
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| Phone | +1 954-484-0051 |
| Fax | 9544854452 |
| Phone | +1 305-824-8880 |
Authorized person
| Name | DR. CHARLENE M GRECSEK |
| Role | PROGRAM DIRECTOR |
| Phone | 9544840051 |
Taxonomy
| Taxonomy Code | 101YP2500X - Professional Counselor |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP PROVIDER NUM |
| Number | 209943 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MARIA FLORA C | Agent | 6175 NW 167TH ST, MIAMI, FL, 33015 |
| Name | Role | Address |
|---|---|---|
| FLORA MARIA | President | 2800 W OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33311 |
| Name | Role | Address |
|---|---|---|
| FLORA MARIA | Director | 2800 W OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33311 |
| FLORA CHARLES E | Director | 2800 W OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33311 |
| Name | Role | Address |
|---|---|---|
| FLORA CHARLES E | Secretary | 2800 W OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33311 |
| Name | Role | Address |
|---|---|---|
| FLORA CHARLES E | Treasurer | 2800 W OAKLAND PARK BLVD, FT LAUDERDALE, FL, 33311 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-20 | MARIA, FLORA CEO/PRE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-02-04 | 6175 NW 167TH ST, G-15, MIAMI, FL 33015 | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-11 | 2800 W OAKLAND PARK BLVD, SUITE 206, FT LAUDERDALE, FL 33311 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-04-29 |
| ANNUAL REPORT | 2007-04-29 |
| ANNUAL REPORT | 2006-04-30 |
| ANNUAL REPORT | 2005-04-20 |
| ANNUAL REPORT | 2004-02-04 |
| ANNUAL REPORT | 2003-03-11 |
| Domestic Profit | 2002-01-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
