| Entity Name: | NORTH GENERAL CENTER OF MEDICINE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 08 Aug 2003 (21 years ago) |
| Document Number: | P03000087292 |
| FEI/EIN Number | 56-2388748 |
| Address: | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 |
| Mail Address: | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730397555 | 2007-05-18 | 2022-11-11 | 1325 S CONGRESS AVE, BOYNTON BEACH, FL, 334265876, US | 1325 S CONGRESS AVE STE 101, BOYNTON BEACH, FL, 334265802, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-733-2929 |
| Fax | 5617368467 |
Authorized person
| Name | DR. JEAN LAVENTURE RENELIEN |
| Role | OWNER |
| Phone | 5614146248 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | ME86189 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 265955700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RENELIEN, JEAN L | Agent | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 |
| Name | Role | Address |
|---|---|---|
| RENELIEN, JEAN L | DR. | 1325 S Congress Ave, Suite 101 Boynton Beach, FL 33426-5802 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-03-21 | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 | No data |
| CHANGE OF MAILING ADDRESS | 2023-03-21 | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-21 | 1325 S Congress Ave, Suite 101, Boynton Beach, FL 33426-5802 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-04-28 | RENELIEN, JEAN L | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-03-31 |
| ANNUAL REPORT | 2021-03-22 |
| ANNUAL REPORT | 2020-03-24 |
| ANNUAL REPORT | 2019-03-05 |
| ANNUAL REPORT | 2018-04-04 |
| ANNUAL REPORT | 2017-03-29 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-03-13 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
