| Entity Name: | PEMBROKE VILLAGE MEDICAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 13 Jan 2009 (16 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P09000003588 |
| FEI/EIN Number | 264037880 |
| Address: | 13550 S.W. 10TH STREET, SUITE B, PEMBROKE PINES, FL, 33027 |
| Mail Address: | 1090 JUPITER PARK DR, SUITE 101, JUPITER, FL, 33458, US |
| ZIP code: | 33027 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235378837 | 2009-02-05 | 2014-12-29 | 250 S. CENTRAL BLVD, SUITE 207, JUPITER, FL, 33458, US | 13550 SW 10TH ST, PEMBROKE PINES, FL, 330276445, US | |||||||||||||||||||||||||
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| Phone | +1 561-745-3877 |
| Fax | 5617453866 |
| Phone | +1 954-435-6001 |
| Fax | 9544356137 |
Authorized person
| Name | ROBERT D CAMERLINCK |
| Role | PRESIDENT |
| Phone | 5617453877 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PTAN |
| Number | DA777A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DANIELS ALYS N | Agent | 701 US HIGHWAY ONE, NORTH PALM BEACH, FL, 33408 |
| Name | Role | Address |
|---|---|---|
| BANSAL RAJENDRA M | President | 875 N. MILITARY TRAIL, # 200, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| BANSAL RAJENDRA M | Secretary | 875 N. MILITARY TRAIL, # 200, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| BANSAL RAJENDRA M | Treasurer | 875 N. MILITARY TRAIL, # 200, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| BANSAL RAJENDRA M | Director | 875 N. MILITARY TRAIL, # 200, JUPITER, FL, 33458 |
| Name | Role | Address |
|---|---|---|
| CAMERLINCK ROBERT D | Manager | 1090 JUPITER PARK DR, JUPITER, FL, 33458 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000010413 | CENTRAL VILLAGE MEDICAL CENTER | EXPIRED | 2016-01-28 | 2021-12-31 | No data | 1090 JUPITER PARK DRIVE, SUITE 101, JUPITER, FL, 33458 |
| G15000069284 | CENTRAL VILLAGE MEDICAL CENTER | ACTIVE | 2015-07-02 | 2025-12-31 | No data | 1090 JUPITER PARK DR, SUITE 201, JUPITER, FL, 33458 |
| G09079900060 | CENTURY VILLAGE MEDICAL CENTER | EXPIRED | 2009-03-20 | 2014-12-31 | No data | PEMBROKE VILLAGE MEDICAL CENTER, INC., 250 S. CENTRAL BLVD. #207, JUPITER, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-06-29 | 13550 S.W. 10TH STREET, SUITE B, PEMBROKE PINES, FL 33027 | No data |
| REGISTERED AGENT NAME CHANGED | 2020-06-29 | DANIELS, ALYS N | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-06-29 | 701 US HIGHWAY ONE, SUITE 402, NORTH PALM BEACH, FL 33408 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-11 | 13550 S.W. 10TH STREET, SUITE B, PEMBROKE PINES, FL 33027 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-19 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-01-23 |
| ANNUAL REPORT | 2016-02-09 |
| ANNUAL REPORT | 2015-04-27 |
| ANNUAL REPORT | 2014-04-21 |
| ANNUAL REPORT | 2013-04-10 |
| ANNUAL REPORT | 2012-03-28 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
