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BROOKFIELD HEALTH & INJURY, LLC

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Company Details

Entity Name: BROOKFIELD HEALTH & INJURY, LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Dissolved
Date Formed: 29 Jun 2011
Date of dissolution: 28 Jun 2018
Business ALEI: 1042265
Business address: 304 FEDERAL ROAD, BROOKFIELD, CT, 06804
Mailing address: 304 FEDERAL RD, BROOKFIELD, CT, 06804
ZIP code: 06804
County: Fairfield
Place of Formation: CONNECTICUT
E-Mail: drrich101@gmail.com

Officer

Name Role Business address Residence address
MONTE MARDER Officer 304 FEDERAL ROAD, BROOKFIELD, CT, 06804, United States 267 SEPARATE ROAD, AMENIA, NY, 12051, United States
RICHARD J. BAILEY Officer 304 FEDERAL ROAD, BROOKFIELD, CT, 06804, United States 76 RIVERSIDE AVE., WESTPORT, CT, 06880, United States
CHRISTOPHER SHAY Officer 304 FEDERAL ROAD, BROOKFIELD, CT, 06804, United States 31 HUDSON DRIVE, NEW FAIRFIELD, CT, 06812, United States

Agent

Name Role Business address Residence address
RICHARD J. BAILEY Agent 304 FEDERAL ROAD, BROOKFIELD, CT, 06804, United States 76 RIVERSIDE AVE., WESTPORT, CT, 06880, United States

National Provider Identifier

NPI Number:
1376829077

Authorized Person:

Name:
RICHARD BAILEY
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QM1300X - Multi-Specialty Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2037750782

Filing

Filing number Filing date Effective date Filing category Filing type Report year
0006207945 2018-06-28 2018-06-28 Dissolution Certificate of Dissolution -
0005312608 2015-04-09 - Annual Report Annual Report 2012
0005312617 2015-04-09 - Annual Report Annual Report 2014
0005312612 2015-04-09 - Annual Report Annual Report 2013
0004402384 2011-06-29 - Business Formation Certificate of Organization -

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Sources: Company Profile on Connecticut's Official State Website

* While we strive to keep this information correct and up-to-date, it is not the primary source, and the dataset source should always be referred to for definitive information