| Entity Name: | PEMBROKE PAVILION PSYCHIATRIC ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 19 Nov 1991 (33 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | S94946 |
| FEI/EIN Number | 65-0310308 |
| Address: | 1000 N. HIATUS RD., STE 140, PEMBROKE PINES, FL 33026 |
| Mail Address: | 1000 N. HIATUS RD., STE 140, PEMBROKE PINES, FL 33026 |
| ZIP code: | 33026 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487962098 | 2010-09-16 | 2010-09-16 | 1000 N HIATUS RD, SUITE 140, PEMBROKE PINES, FL, 330263097, US | 1000 N HIATUS RD, SUITE 140, PEMBROKE PINES, FL, 330263097, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 954-431-9838 |
| Fax | 9544337066 |
Authorized person
| Name | DR. ABRAHAM FLEMENBAUM |
| Role | PRESIDENT |
| Phone | 9544319838 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | ME0025377 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0383290500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ABRAHAM FLEMENBAUM, M.D. | Agent | 1000 N. HIATUS ROAD, SUITE 140, PEMBROKE PINES, FL 33026 |
| Name | Role | Address |
|---|---|---|
| FLEMENBAUM, A. M.D. | President | 1000 N. HIATUS RD., #160, PEMBROKE PINES, FL 33026 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-04-30 | 1000 N. HIATUS RD., STE 140, PEMBROKE PINES, FL 33026 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-30 | 1000 N. HIATUS RD., STE 140, PEMBROKE PINES, FL 33026 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-30 | 1000 N. HIATUS ROAD, SUITE 140, PEMBROKE PINES, FL 33026 | No data |
| CANCEL ADM DISS/REV | 2006-11-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 1996-04-16 | ABRAHAM FLEMENBAUM, M.D. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-03-01 |
| ANNUAL REPORT | 2019-03-31 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-03-25 |
| ANNUAL REPORT | 2016-02-02 |
| ANNUAL REPORT | 2015-04-04 |
| ANNUAL REPORT | 2014-01-11 |
| ANNUAL REPORT | 2013-04-26 |
| ANNUAL REPORT | 2012-04-23 |
| ANNUAL REPORT | 2011-04-27 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
