| Entity Name: | PEDIATRIC CARDIAC CRITICAL CARE OF SOUTH FLORIDA, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Jan 2020 (5 years ago) |
| Document Number: | P20000002387 |
| FEI/EIN Number | 84-4304547 |
| Address: | 1117 EAST HALLANDALE BEACH BLVD, HALLANDALE, FL, 33009 |
| Mail Address: | 1117 EAST HALLANDALE BEACH BLVD, HALLANDALE, FL, 33009 |
| ZIP code: | 33009 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376272591 | 2022-06-06 | 2022-06-06 | 1117 E HALLANDALE BEACH BLVD, HALLANDALE BEACH, FL, 33009, US | 3501 JOHNSON ST, HOLLYWOOD, FL, 33021, US | |||||||||||||||||||
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| Phone | +1 954-457-8771 |
| Phone | +1 954-987-2000 |
Authorized person
| Name | ALLAN MITCHELL GREISSMAN |
| Role | PHYSICIAN |
| Phone | 9544545131 |
Taxonomy
| Taxonomy Code | 2080P0202X - Pediatric Cardiology Physician |
| Is Primary | No |
| Taxonomy Code | 2080P0203X - Pediatric Critical Care Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Lavandosky Gerald | Agent | 1117 EAST HALLANDALE BEACH BLVD, HALLANDALE, FL, 33009 |
| Name | Role | Address |
|---|---|---|
| Adler Jason | Treasurer | 3501 JOHNSON STREET, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| Lavandosky Gerald | President | 1117 EAST HALLANDALE BEACH BLVD, HALLANDALE, FL, 33009 |
| Name | Role | Address |
|---|---|---|
| Adler Jason | Secretary | 3501 JOHNSON STREET, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-03-10 | Lavandosky, Gerald | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-10 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-04-04 |
| ANNUAL REPORT | 2021-04-15 |
| Domestic Profit | 2020-01-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
