| Entity Name: | PALMETTO SUB ACUTE CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jul 1996 (29 years ago) |
| Document Number: | P96000062134 |
| FEI/EIN Number | 650681540 |
| Address: | 13100 MUSTANG TRAIL, SOUTHWEST RANCHES, FL, 33330, US |
| Mail Address: | 13100 MUSTANG TRAIL, SOUTHWEST RANCHES, FL, 33330, US |
| ZIP code: | 33330 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1780696336 | 2006-08-12 | 2009-01-15 | 7600 SW 8TH ST, MIAMI, FL, 331444462, US | 7600 SW 8TH ST, MIAMI, FL, 331444462, US | |||||||||||||||||||||||||
|
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| Phone | +1 305-261-2525 |
| Fax | 3052615232 |
Authorized person
| Name | MR. KHALID MIRZA |
| Role | PRESIDENT |
| Phone | 3052612525 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF 1423096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021280600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MIRZA KHALID M | Agent | 13100 Mustang Trail, Southwest Ranches, FL, 33330 |
| Name | Role | Address |
|---|---|---|
| MIRZA KHALID M | Director | 13100 Mustang Trail, Southwest Ranches, FL, 33330 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-21 | 13100 MUSTANG TRAIL, SOUTHWEST RANCHES, FL 33330 | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-21 | 13100 MUSTANG TRAIL, SOUTHWEST RANCHES, FL 33330 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-16 | 13100 Mustang Trail, Southwest Ranches, FL 33330 | No data |
| REGISTERED AGENT NAME CHANGED | 2004-04-14 | MIRZA, KHALID M | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J02000442537 | LAPSED | 02-13329 CA 13 | MIAMI-DADE CIRCUIT COURT | 2002-10-09 | 2007-11-07 | $67033.97 | COMPSCRIPT, INC., 1225 BROKEN SOUND PKWY, BOCA RATON, FL 33487 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-07-12 |
| ANNUAL REPORT | 2023-05-01 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-23 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-01-30 |
| ANNUAL REPORT | 2016-02-16 |
| ANNUAL REPORT | 2015-01-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
