| Entity Name: | JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 27 Jun 1967 (58 years ago) |
| Document Number: | 712996 |
| FEI/EIN Number | 591235617 |
| Address: | 5607 NW 27TH AVENUE, SUITE #1, MIAMI, FL, 33142 |
| Mail Address: | 5607 NW 27TH AVENUE, SUITE #1, MIAMI, FL, 33142 |
| ZIP code: | 33142 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1912667502 | 2021-12-22 | 2021-12-22 | 5607 NW 27TH AVE STE 1, MIAMI, FL, 331422826, US | 901 E 10TH AVE STE 39, HIALEAH, FL, 330103766, US | |||||||||||||||||||
|
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| Phone | +1 305-805-1700 |
Authorized person
| Name | ANNIE R NEASMAN |
| Role | PRESIDENT AND CEO |
| Phone | 3058051700 |
Taxonomy
| Taxonomy Code | 3336C0003X - Community/Retail Pharmacy |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE PHARMACY LICENSE |
| Number | PH33639 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CLYNE REGINALD J | Agent | C/O QUINTAIROS, PRIETO, WOOD & BOYER PA, MIAMI, FL, 33156 |
| Name | Role | Address |
|---|---|---|
| TAYLOR-WOOTEN IRENE | Chairman | 5607 NW 27TH AVENUE, SUITE 1, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| LIGHTFOOT ANGEL D | Secretary | 5607 NW 27TH AVENUE, SUITE 1, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| HAWKINS RYAN R | President | 5607 NW 27TH AVENUE, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| HAWKINS RYAN R | Chief Executive Officer | 5607 NW 27TH AVENUE, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| Jones Carla Esq. | Treasurer | 5607 NW 27TH AVENUE, MIAMI, FL, 33142 |
| Name | Role | Address |
|---|---|---|
| DUBOSE SHERWOOD | Director | 5607 NW 27 AVENUE, SUITE 1, MIAMI, FL, 33142 |
| Rosete Isabella | Director | 5607 NW 27TH AVENUE, SUITE 1, MIAMI, FL, 33142 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000034536 | FLAMINGO PHARMACY | ACTIVE | 2022-03-16 | 2027-12-31 | No data | 5607 NW 27TH AVENUE SUITE 1, MIAMI, FL, 33142 |
| G22000034534 | MAIN PHARMACY | ACTIVE | 2022-03-16 | 2027-12-31 | No data | 5607 NW 27TH AVENUE SUITE 1, MIAMI, FL, 33142 |
| G22000035416 | BARBARA JORDAN PHARMACY | ACTIVE | 2022-03-16 | 2027-12-31 | No data | 5607 NW 27TH AVENUE SUITE 1, MIAMI, FL, 33142 |
| G17000066181 | JESSIE TRICE COMMUNITY HEALTH CENTER, INC. | EXPIRED | 2017-06-15 | 2022-12-31 | No data | 5607 NW 27TH AVE, SUITE #1, MIAMI, FL, 33142 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2018-02-27 | No data | No data |
| AMENDMENT | 2017-12-28 | No data | No data |
| NAME CHANGE AMENDMENT | 2017-05-01 | JESSIE TRICE COMMUNITY HEALTH SYSTEM, INC. | No data |
| NAME CHANGE AMENDMENT | 2008-01-14 | JESSIE TRICE COMMUNITY HEALTH CENTER, INC. | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
