| Entity Name: | BRIGHT CARE FAMILY MEDICINE CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 25 May 2022 (3 years ago) |
| Document Number: | P22000042980 |
| FEI/EIN Number | 88-1596895 |
| Address: | 1920 E HALLANDALE BLVD, STE. 901, HALLANDALE BEACH, FL 33009 |
| Mail Address: | 1920 E HALLANDALE BLVD, STE. 901, HALLANDALE BEACH, FL 33009 |
| ZIP code: | 33009 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659001741 | 2022-06-13 | 2022-10-21 | 1920 E HALLANDALE BEACH BLVD STE 901, HALLANDALE BEACH, FL, 330094726, US | 1920 E HALLANDALE BLVD, SUITE 901, HALLANDALE BEACH, FL, 33009, US | |||||||||||||||||||||||||||
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| Phone | +1 786-733-1066 |
| Fax | 7868393258 |
Authorized person
| Name | DR. DMITRY ZHUKOVSKI |
| Role | MEDICAL DIRECTOR |
| Phone | 7867331066 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113967000 |
| State | FL |
| Issuer | DEPARTMENT OF HEALTH OSTEOPATHIC PHYSICIAN LICENSE |
| Number | OS18656 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ZHUKOVSKI, DMITRY | Agent | 1920 E HALLANDALE BLVD, STE. 901, HALLANDALE BEACH, FL 33009 |
| Name | Role | Address |
|---|---|---|
| ZHUKOVSKI, DMITRY | President | 1920 E HALLANDALE BLVD, STE. 901, HALLANDALE BEACH, FL 33009 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000072932 | BRIGHT CARE FAMILY MEDICINE | ACTIVE | 2023-06-15 | 2028-12-31 | No data | 1920 E HALLANDALE BEACH BLVD, STE 901, HALLANDALE BEACH, FL, 33009 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-10 |
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-03-29 |
| Domestic Profit | 2022-05-25 |
Date of last update: 11 Feb 2025
Sources: Florida Department of State
