| Entity Name: | HOLLYWOOD MOBILE DIAGNOSTICS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Aug 2006 (18 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | P06000111577 |
| FEI/EIN Number | 205543018 |
| Address: | 2216 NORTH 20TH AVENUE, HOLLYWOOD, FL, 33020 |
| Mail Address: | 2216 NORTH 20TH AVENUE, HOLLYWOOD, FL, 33020 |
| ZIP code: | 33020 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669541454 | 2006-11-07 | 2008-06-05 | 2216 N 20TH AVE, HOLLYWOOD, FL, 330202108, US | 2216 N 20TH AVE, HOLLYWOOD, FL, 330202108, US | |||||||||||||||||||||||||
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| Phone | +1 954-965-0054 |
| Fax | 9549655967 |
Authorized person
| Name | ERIC SHARENOW |
| Role | OWNER PRESIDENT |
| Phone | 9549650054 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| Is Primary | No |
| Taxonomy Code | 335V00000X - Portable X-ray and/or Other Portable Diagnostic Imaging Supplier |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 510063100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BLAIR LAURENCE I | Agent | 100 WEST CYPRESS CREEK ROAD, FORT LAUDERDALE, FL, 33309 |
| Name | Role | Address |
|---|---|---|
| SHARENOW ERIC | Director | 2216 NORTH 20TH AVENUE, HOLLYWOOD, FL, 33020 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-04-24 |
| ANNUAL REPORT | 2007-04-16 |
| Domestic Profit | 2006-08-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
