| Entity Name: | PHOENIX CLINIC, INC. OF BROWARD |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Dec 2003 (21 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P03000153442 |
| FEI/EIN Number | 200633545 |
| Address: | 5975 West Sunrise Blvd., Sunrise, FL, 33313, US |
| Mail Address: | 5975 West Sunrise Blvd., Sunrise, FL, 33313, US |
| ZIP code: | 33313 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811927262 | 2006-07-03 | 2011-08-08 | 2212 SW 60TH TERRACE, MIRAMAR, FL, 33023, US | 2212 SW 60TH TERRACE, MIRAMAR, FL, 33023, US | |||||||||||||||||||
|
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| Phone | +1 954-491-2133 |
| Fax | 9544912344 |
Authorized person
| Name | BONNIE GRAHAM |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 3058913439 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 1006AD354501 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| GRAHAM BONNIE | Agent | 5975 West Sunrise Blvd., Sunrise, FL, 33313 |
| Name | Role | Address |
|---|---|---|
| GRAHAM BONNIE | President | 3700 SW 54TH STREET, DANIA, FL, 33312 |
| Name | Role | Address |
|---|---|---|
| GRAHAM BONNIE | Director | 3700 SW 54TH STREET, DANIA, FL, 33312 |
| GRAHAM-JOHNS MONIQUE | Director | 2810 Jockey Circle W., DAVIE, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| GRAHAM-JOHNS MONIQUE | Vice President | 2810 Jockey Circle W., DAVIE, FL, 33330 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000030098 | LOTUS | EXPIRED | 2012-03-28 | 2017-12-31 | No data | 2208 S.W. 60TH TERRACE, MIRAMAR, FL, 33023, US |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-20 | 5975 West Sunrise Blvd., 108, Sunrise, FL 33313 | No data |
| CHANGE OF MAILING ADDRESS | 2014-01-20 | 5975 West Sunrise Blvd., 108, Sunrise, FL 33313 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-20 | 5975 West Sunrise Blvd., 108, Sunrise, FL 33313 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-03-03 | GRAHAM, BONNIE | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-01-20 |
| ANNUAL REPORT | 2013-04-01 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-03-04 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-03-03 |
| ANNUAL REPORT | 2008-01-16 |
| ANNUAL REPORT | 2007-01-12 |
| ANNUAL REPORT | 2006-05-01 |
| ANNUAL REPORT | 2005-04-04 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
