| Entity Name: | FORWARD REHABILITATION OF PALM BEACH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Sep 2004 (20 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P04000132541 |
| FEI/EIN Number | 201646903 |
| Address: | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Mail Address: | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104842079 | 2006-07-14 | 2020-08-22 | 4733 W ATLANTIC AVE, SUITE C14, DELRAY BEACH, FL, 334453706, US | 4733 W ATLANTIC AVE, SUITE C14, DELRAY BEACH, FL, 334453706, US | |||||||||||||||
|
|||||||||||||||||||
| Phone | +1 888-381-4340 |
Authorized person
| Name | MR. MARK B DELVAUX |
| Role | PRESIDENT |
| Phone | 8883814340 |
Taxonomy
| Taxonomy Code | 261QR0401X - Comprehensive Outpatient Rehabilitation Facility (CORF) |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| DELVAUX MARK B | Agent | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| DELVAUX MARK B | President | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| DELVAUX MARK B | Secretary | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| DELVAUX MARK B | Director | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| KLUDT PAUL | Director | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| KLUDT PAUL | Vice President | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| KLUDT PAUL | Treasurer | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL, 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-02-15 | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL 33467 | No data |
| CHANGE OF MAILING ADDRESS | 2012-02-15 | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL 33467 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-02-15 | 7691 SPRINGFIELD LAKE DR, LAKE WORTH, FL 33467 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-29 | DELVAUX, MARK BPSD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-23 |
| ANNUAL REPORT | 2012-02-15 |
| ANNUAL REPORT | 2011-04-19 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-01-13 |
| ANNUAL REPORT | 2008-01-28 |
| ANNUAL REPORT | 2007-04-18 |
| ANNUAL REPORT | 2006-04-28 |
| ANNUAL REPORT | 2005-04-29 |
| Domestic Profit | 2004-09-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
