| Entity Name: | SUSAN SAGMAN PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 May 2004 (21 years ago) |
| Date of dissolution: | 26 Sep 2008 (16 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2008 (16 years ago) |
| Document Number: | P04000073603 |
| FEI/EIN Number | 432050607 |
| Address: | 21691 ABINGTON COURT, BOCA RATON, FL, 33428 |
| Mail Address: | 21691 ABINGTON COURT, BOCA RATON, FL, 33428 |
| ZIP code: | 33428 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841473741 | 2007-12-13 | 2007-12-13 | 21691 ABINGTON CT, BOCA RATON, FL, 334284831, US | 21691 ABINGTON CT, BOCA RATON, FL, 334284831, US | |||||||||||||||||||||||||
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| Phone | +1 561-929-0996 |
| Fax | 5612186029 |
Authorized person
| Name | MRS. SUSAN FAITH SAGMAN |
| Role | PRESIDENT |
| Phone | 5619290996 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | SW3461 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 8118515 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOLDBERG SUSAN | Agent | 21691 ABINGTON COURT, BOCA RATON, FL, 33428 |
| Name | Role | Address |
|---|---|---|
| GOLDBERG SUSAN | President | 21691 ABINGTON COURT, BOCA RATON, FL, 33428 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-27 | 21691 ABINGTON COURT, BOCA RATON, FL 33428 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-27 | 21691 ABINGTON COURT, BOCA RATON, FL 33428 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-27 | GOLDBERG, SUSAN | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-27 | 21691 ABINGTON COURT, BOCA RATON, FL 33428 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2007-07-09 |
| ANNUAL REPORT | 2006-04-28 |
| ANNUAL REPORT | 2005-04-27 |
| Domestic Profit | 2004-05-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
