| Entity Name: | NORTH BROWARD REHABILITATION ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 22 Jul 1994 (31 years ago) |
| Date of dissolution: | 22 Sep 2000 (24 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2000 (24 years ago) |
| Document Number: | P94000054516 |
| FEI/EIN Number | 65-0513923 |
| Address: | 1 W SAMPLE RD # 301, POMPANO BCH, FL 33064 |
| Mail Address: | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| ZIP code: | 33064 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053521427 | 2007-05-23 | 2012-07-02 | 1 W SAMPLE RD, SUITE 301, DEERFIELD BEACH, FL, 330643547, US | 1 W SAMPLE RD, SUITE 301, DEERFIELD BEACH, FL, 330643547, US | |||||||||||||||||||||||||||||||
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| Phone | +1 954-941-5355 |
| Fax | 9549415675 |
Authorized person
| Name | JEFFREY ALLAN SAMUELS |
| Role | PRESIDENT |
| Phone | 9549415355 |
Taxonomy
| Taxonomy Code | 208100000X - Physical Medicine & Rehabilitation Physician |
| License Number | ME60132 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 053956200 |
| State | FL |
| Issuer | NPI JEFFREY SAMUELS MD |
| Number | 1396880043 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SAMUELS, JEFFREY A | Agent | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| Name | Role | Address |
|---|---|---|
| SAMUELS, JEFFREY A | President | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| Name | Role | Address |
|---|---|---|
| SAMUELS, JEFFREY A | Director | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| SAMUELS, VONDA L | Director | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| Name | Role | Address |
|---|---|---|
| SAMUELS, VONDA L | Secretary | 2541 NE 35TH ST, LIGHTHOUSE POINT, FL 33064 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1997-05-05 | 1 W SAMPLE RD # 301, POMPANO BCH, FL 33064 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 1999-09-13 |
| ANNUAL REPORT | 1998-06-18 |
| ANNUAL REPORT | 1997-05-05 |
| ANNUAL REPORT | 1996-02-22 |
| ANNUAL REPORT | 1995-05-01 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2599248901 | 2021-04-27 | 0455 | PPS | 3235 NW 2nd St Apt 108, Pompano Beach, FL, 33069-2646 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6666567710 | 2020-05-01 | 0455 | PPP | 3235 NW 2ND ST APT 108, POMPANO BEACH, FL, 33069-2646 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
