| Entity Name: | COUNTYLINE SUPPORT SERVICES, CORP. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 29 May 2018 (7 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P18000048710 |
| FEI/EIN Number | 83-0721460 |
| Address: | 2114 N FLAMINGO RD, #166, PEMBROKE PINES, FL, 33028 |
| Mail Address: | 2114 N FLAMINGO RD, #166, PEMBROKE PINES, FL, 33028 |
| ZIP code: | 33028 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265911531 | 2018-08-08 | 2018-08-08 | 2114 N FLAMINGO RD # 166, PEMBROKE PINES, FL, 330283501, US | 2114 N FLAMINGO RD # 166, PEMBROKE PINES, FL, 330283501, US | |||||||||||||||||||
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| Phone | +1 954-632-9891 |
Authorized person
| Name | MAUVA ANGELA MUNFORD |
| Role | OWNER |
| Phone | 9546329891 |
Taxonomy
| Taxonomy Code | 261QD1600X - Developmental Disabilities Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100207900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRISIBE MAUVA | Agent | 2114 N FLAMINGO RD, PEMBROKE PINES, FL, 33028 |
| Name | Role | Address |
|---|---|---|
| BRISIBE MAUVA | President | 2114 N FLAMINGO RD, #166, PEMBROKE PINES, FL, 33028 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| Domestic Profit | 2018-05-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
