| Entity Name: | PHOENIX HOUSE OF SUPPORT, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Jul 2013 (12 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P13000062105 |
| FEI/EIN Number | APPLIED FOR |
| Address: | 8902 SW 208TH TER, CUTLER BAY, FL, 33189, US |
| Mail Address: | 8902 SW 208TH TER, CUTLER BAY, FL, 33189, US |
| ZIP code: | 33189 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356897300 | 2016-08-30 | 2016-08-30 | 8902 SW 208TH TER, CUTLER BAY, FL, 331893884, US | 8902 SW 208TH TER, CUTLER BAY, FL, 331893884, US | |||||||||||||||||||||||||
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| Phone | +1 786-301-1571 |
| Fax | 3052338594 |
Authorized person
| Name | TAMARA VIQUILLON |
| Role | OWNER |
| Phone | 7863011571 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| License Number | 016029700 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016029700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VIQUILLON TAMARA | Agent | 8902 SW 208TH TER, CUTLER BAY, FL, 33189 |
| Name | Role | Address |
|---|---|---|
| VIQUILLON TAMARA | President | 8902 SW 208TH TER, CUTLER BAY, FL, 33189 |
| Name | Role | Address |
|---|---|---|
| VIQUILLON TAMARA | Director | 8902 SW 208TH TER, CUTLER BAY, FL, 33189 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2016-05-17 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-05-17 | 8902 SW 208TH TER, CUTLER BAY, FL 33189 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-05-17 | 8902 SW 208TH TER, CUTLER BAY, FL 33189 | No data |
| CHANGE OF MAILING ADDRESS | 2016-05-17 | 8902 SW 208TH TER, CUTLER BAY, FL 33189 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-05-17 | VIQUILLON, TAMARA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2016-05-17 |
| ANNUAL REPORT | 2014-04-30 |
| Domestic Profit | 2013-07-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
