| Entity Name: | BREATH OF LIFE MEDICAL CENTER INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 09 Aug 2017 (7 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 04 Sep 2019 (5 years ago) |
| Document Number: | P17000066883 |
| FEI/EIN Number | 82-2442721 |
| Address: | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Mail Address: | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| ZIP code: | 33063 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750890513 | 2017-09-25 | 2021-04-06 | 5090 COCONUT CREEK PKWY, MARGATE, FL, 330633942, US | 5090 COCONUT CREEK PKWY, MARGATE, FL, 33063, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 954-933-2731 |
| Fax | 9546578535 |
| Phone | +1 703-867-6672 |
| Fax | 7034411905 |
Authorized person
| Name | FRANCESSE M BATAILLE |
| Role | CEO |
| Phone | 7034411905 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | ME109600 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105730700 |
| State | FL |
| Issuer | INDIVIDUAL NPI |
| Number | 1255371613 |
| State | VA |
| Name | Role | Address |
|---|---|---|
| BATAILLE, FRANCESSE M | Agent | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| BATAILLE, FRANCESSE M | President | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| LAURENT, YVES M | Chief Financial Officer | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| GERMAIN, GERLY J | Vice President | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Name | Role | Address |
|---|---|---|
| MICHEL BATAILLE, FRANTZ | Treasurer | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000106119 | BREATH OF LIFE MEDICAL CENTER | EXPIRED | 2017-09-25 | 2022-12-31 | No data | 3771 FETTLER PARK DRIVE, DUMFRIES, VA, 22026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2019-09-04 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-07-30 | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 | No data |
| CHANGE OF MAILING ADDRESS | 2019-07-30 | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 | No data |
| AMENDMENT | 2019-07-29 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-07-29 | 5090 COCONUT CREEK PKWY, MARGATE, FL 33063 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-05-09 |
| ANNUAL REPORT | 2022-07-15 |
| ANNUAL REPORT | 2021-04-06 |
| ANNUAL REPORT | 2020-07-07 |
| Amendment | 2019-09-04 |
| Amendment | 2019-07-29 |
| ANNUAL REPORT | 2019-03-26 |
| ANNUAL REPORT | 2018-04-30 |
| Domestic Profit | 2017-08-09 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
