| Entity Name: | PALM BEACH REHABILITATION & MEDICAL CENTER INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Nov 2010 (14 years ago) |
| Date of dissolution: | 27 Sep 2013 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2013 (11 years ago) |
| Document Number: | P10000096879 |
| FEI/EIN Number | 274074907 |
| Address: | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL, 33415 |
| Mail Address: | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL, 33415 |
| ZIP code: | 33415 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386941110 | 2011-02-14 | 2011-02-14 | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL, 334152890, US | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL, 334152890, US | |||||||||||||||||||||||
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| Phone | +1 561-686-9091 |
Authorized person
| Name | MR. ALBERTO BAEZ KIM |
| Role | PRESIDENT |
| Phone | 5616869091 |
Taxonomy
| Taxonomy Code | 276400000X - Substance Use Disorder Rehabilitation Hospital Unit |
| License Number | 9572 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AHCA LICENSE |
| Number | 9572 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAEZ KIM ALBERTO | Agent | 4524 GUN CLUB RD, WEST PALM BEACH, FL, 33415 |
| Name | Role | Address |
|---|---|---|
| BAEZ KIM ALBERTO | President | 4524 GUN CLUB RD #211, WEST PALM BEACH, FL, 33415 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| REINSTATEMENT | 2012-01-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| AMENDMENT | 2010-12-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-12-14 | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL 33415 | No data |
| CHANGE OF MAILING ADDRESS | 2010-12-14 | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL 33415 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-12-14 | 4524 GUN CLUB RD, SUITE 211, WEST PALM BEACH, FL 33415 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2012-01-06 |
| Amendment | 2010-12-14 |
| Domestic Profit | 2010-11-30 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
