| Entity Name: | SIGNATURE HEALTH SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 May 1998 (27 years ago) |
| Date of dissolution: | 28 Sep 2012 (12 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P98000041085 |
| FEI/EIN Number | 650832664 |
| Address: | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL, 33069 |
| Mail Address: | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL, 33069 |
| ZIP code: | 33069 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619995578 | 2006-07-18 | 2009-12-16 | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL, 330691989, US | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL, 330691989, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 954-972-6450 |
| Fax | 9549727028 |
Authorized person
| Name | MR. DALE GIBSON |
| Role | EXECUTIVE DIRECTOR |
| Phone | 9549726450 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | HCC4684 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | HCC4684 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 255566200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GIBSON DALE | Agent | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL, 33069 |
| Name | Role | Address |
|---|---|---|
| GIBSON DALE | DCOB | 1711 HAMMONDVILLE ROAD, POMPANO, FL, 33069 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000012560 | SUNSHINE HEALTH CENTER & VISITING PHYSICIANS | EXPIRED | 2011-02-02 | 2016-12-31 | No data | 1711 HAMMONDVILLE ROAD, POMPANO BEACH, FL, 33069 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| REINSTATEMENT | 2011-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| REINSTATEMENT | 2010-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| AMENDMENT | 2008-01-18 | No data | No data |
| AMENDMENT | 2007-04-19 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2003-03-14 | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL 33069 | No data |
| CHANGE OF MAILING ADDRESS | 2003-03-14 | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL 33069 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-03-14 | 1711 HAMMONDVILLE RD, POMPANO BEACH, FL 33069 | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2011-10-18 |
| REINSTATEMENT | 2010-10-08 |
| ANNUAL REPORT | 2009-06-18 |
| ANNUAL REPORT | 2008-03-17 |
| Amendment | 2008-01-18 |
| Amendment | 2007-04-19 |
| ANNUAL REPORT | 2007-04-17 |
| ANNUAL REPORT | 2006-01-26 |
| ANNUAL REPORT | 2005-03-28 |
| ANNUAL REPORT | 2004-02-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
