| Entity Name: | LA CLINIQUE 300, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
LA CLINIQUE 300, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 01 Jul 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2021 (4 years ago) |
| Document Number: | P15000056939 |
| FEI/EIN Number |
65-0167934
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 2630 N. ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| Mail Address: | 2630 N. ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| ZIP code: | 33311 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689059453 | 2015-07-22 | 2016-05-09 | 2630 N ANDREWS AVE, WILTON MANORS, FL, 333112550, US | 2630 N ANDREWS AVE, WILTON MANORS, FL, 333112550, US | |||||||||||||||||||||||||
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| Phone | +1 954-525-4900 |
| Fax | 9543963110 |
Authorized person
| Name | DR. JOSEPH FANFAN |
| Role | PRESIDENT |
| Phone | 9545254900 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | ME43065 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 068166100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FANFAN JOSEPH JR., MD | President | 2630 N. ANDREWS AVENUE, WILTON MANOR, FL, 33311 |
| FANFAN KETLYNE | Executive Vice President | 2630 N. ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| FANFAN JOSEPH JR. | CB | 2630 N. ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| FANFAN JOSEPH JR | Agent | 2630 N. ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000058652 | JOSEPH FANFAN JR MD PA | EXPIRED | 2016-06-14 | 2021-12-31 | - | 2630 N ANDREWS AVENUE, WILTON MANORS, FL, 33311 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-09-28 | - | - |
| REGISTERED AGENT NAME CHANGED | 2021-09-28 | FANFAN, JOSEPH, JR | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | - | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-10 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-21 |
| ANNUAL REPORT | 2022-02-28 |
| REINSTATEMENT | 2021-09-28 |
| ANNUAL REPORT | 2020-03-03 |
| ANNUAL REPORT | 2019-02-20 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-07 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2860147904 | 2020-06-12 | 0455 | PPP | 2630 North Andrews Avenue, Wilton Manors, FL, 33311 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 03 Apr 2025
Sources: Florida Department of State
