| Entity Name: | SHALOM MENTAL HEALTH AND WELLNESS INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Aug 2016 (8 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 15 Oct 2020 (4 years ago) |
| Document Number: | P16000069416 |
| FEI/EIN Number | 81-3659155 |
| Address: | 2525 embassy drive s,, cooper city, FL, 33026, US |
| Mail Address: | 2525 embassy drive s,, cooper city, FL, 33026, US |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568077709 | 2020-09-14 | 2022-06-10 | 18581 SW 44TH ST, MIRAMAR, FL, 330296215, US | 3157 N UNIVERSITY DR, HOLLYWOOD, FL, 330242258, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-849-4800 |
| Fax | 9543228981 |
Authorized person
| Name | DR. CAROLE L WILKINSON |
| Role | OWNER OF ENTITY |
| Phone | 3052844656 |
Taxonomy
| Taxonomy Code | 163WP0808X - Psychiatric/Mental Health Registered Nurse |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | 116663188 |
| Number | 116663188 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILKINSON CAROLE | Agent | 18581 SW 44TH ST, MIRAMAR, FL, 33029 |
| Name | Role | Address |
|---|---|---|
| WILKINSON CAROLE DR. | President | 18581 SW 44TH ST, MIRAMAR, FL, 33029 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-05-12 | 2525 embassy drive s,, unit 14, cooper city, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2022-05-12 | 2525 embassy drive s,, unit 14, cooper city, FL 33026 | No data |
| REINSTATEMENT | 2020-10-15 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-10-15 | WILKINSON, CAROLE | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-07 |
| ANNUAL REPORT | 2024-01-10 |
| ANNUAL REPORT | 2023-06-14 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-28 |
| REINSTATEMENT | 2020-10-15 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-05-01 |
| Domestic Profit | 2016-08-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
