| Entity Name: | CORAL INJURY CENTER INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Sep 2004 (20 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 31 Oct 2017 (7 years ago) |
| Document Number: | P04000127903 |
| FEI/EIN Number | 770647464 |
| Address: | 1490 S MILITARY TRAIL, WEST PALM BEACH, FL, 33415, US |
| Mail Address: | 1490 S MILITARY TRAIL, WEST PALM BEACH, FL, 33415, US |
| ZIP code: | 33415 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912671652 | 2021-08-05 | 2022-03-30 | 1490 S MILITARY TRL STE 8, WEST PALM BEACH, FL, 334159141, US | 1490 S MILITARY TRL STE 7, WEST PALM BEACH, FL, 334159141, US | |||||||||||||||||||||
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| Phone | +1 561-679-0512 |
| Phone | +1 561-323-2552 |
Authorized person
| Name | BEATRIZ RODRIGUEZ |
| Role | OFFICE MANAGER |
| Phone | 5613232552 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108796800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ALVAREZ FIDEL LESTER | Agent | 1490 S MILITARY TRAIL, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| ALVAREZ FIDEL LESTER | President | 1490 S MILITARY TRAIL, WEST PALM BEACH, FL, 33415 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000022422 | CORAL MEDICAL CENTER | ACTIVE | 2021-02-16 | 2026-12-31 | No data | 1490 S MILITARY TRAIL STE 7, WEST PALM BEACH, FL, 33415 |
| G20000145630 | CORAL BEHAVIORAL SERVICES | ACTIVE | 2020-11-12 | 2025-12-31 | No data | 1490 S MILITARY TRAIL. STE 7, WEST PALM BEACH, FL, 33415 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-11-16 | 1490 S MILITARY TRAIL, STE 7, WEST PALM BEACH, FL 33415 | No data |
| CHANGE OF MAILING ADDRESS | 2020-11-16 | 1490 S MILITARY TRAIL, STE 7, WEST PALM BEACH, FL 33415 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-11-16 | 1490 S MILITARY TRAIL, STE 7, WEST PALM BEACH, FL 33415 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-10-31 | ALVAREZ, FIDEL LESTER | No data |
| REINSTATEMENT | 2017-10-31 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| AMENDMENT | 2011-12-09 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-03-29 |
| ANNUAL REPORT | 2021-01-20 |
| AMENDED ANNUAL REPORT | 2020-11-16 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-03-21 |
| REINSTATEMENT | 2017-10-31 |
| ANNUAL REPORT | 2016-04-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
