| Entity Name: | COVE BEHAVIORAL HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 16 Jul 1973 (52 years ago) |
| Document Number: | 726954 |
| FEI/EIN Number | 591514993 |
| Address: | 4422 EAST COLUMBUS DRIVE, ., TAMPA, FL, 33605, US |
| Mail Address: | 4422 EAST COLUMBUS DRIVE, ., TAMPA, FL, 33605, US |
| ZIP code: | 33605 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215500954 | 2021-07-21 | 2021-10-05 | 4422 E COLUMBUS DR, TAMPA, FL, 336053233, US | 4422 E COLUMBUS DR, TAMPA, FL, 336053233, US | |||||||||||||||||||
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| Phone | +1 813-384-4000 |
Authorized person
| Name | KRISTIN HARE FLAHART |
| Role | CONTRACTS MANAGER |
| Phone | 8133844216 |
Taxonomy
| Taxonomy Code | 291U00000X - Clinical Medical Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024285200 |
| State | FL |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300MB4JDTBXYYQB03 | 726954 | US-FL | GENERAL | ACTIVE | No data | |||||||||||||||||||
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| Legal | C/O ULREY, MARY LYNN, 4422 EAST COLUMBUS DRIVE, TAMPA, US-FL, US, 33605 |
| Headquarters | 4422 East Columbus Drive, Tampa, US-FL, US, 33605 |
Registration details
| Registration Date | 2015-05-27 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2019-11-20 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | 726954 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| COVE BEHAVIORAL HEALTH HEALTH & WELFARE PLAN | 2022 | 591514993 | 2024-01-10 | COVE BEHAVIORAL HEALTH | 152 | |||||||||||||||||||||||||||||||
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| Active participants | 170 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
Signature of
| Role | Plan administrator |
| Date | 2024-01-10 |
| Name of individual signing | DEANNA OBREGON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2017-07-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8133844226 |
| Plan sponsor’s mailing address | 4422 E. COLUMBUS DR., TAMPA, FL, 336053233 |
| Plan sponsor’s address | 4422 E COLUMBUS DR, TAMPA, FL, 336053233 |
Number of participants as of the end of the plan year
| Active participants | 152 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
Signature of
| Role | Plan administrator |
| Date | 2023-01-23 |
| Name of individual signing | DEANNA OBREGON |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2017-07-01 |
| Business code | 813000 |
| Sponsor’s telephone number | 8133844226 |
| Plan sponsor’s mailing address | 4422 E. COLUMBUS DR., TAMPA, FL, 336053233 |
| Plan sponsor’s address | 4422 E COLUMBUS DR, TAMPA, FL, 336053233 |
Number of participants as of the end of the plan year
| Active participants | 170 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
Signature of
| Role | Plan administrator |
| Date | 2022-01-26 |
| Name of individual signing | DEANNA OBREGON |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| OBREGON DEANNA | Agent | 4422 EAST COLUMBUS DRIVE, TAMPA, FL, 33605 |
| Name | Role | Address |
|---|---|---|
| Losat Frank | Boar | 4422 E. Columbus Drive, Tampa, FL, 33605 |
| HORTON EARL | Boar | 30 West Spanish Main, TAMPA, FL, 33609 |
| Williams Robert V | Boar | 201 North Franklin St., #3200, Tampa, FL, 33602 |
| Pariseau Rob | Boar | 4422 E. Columbus Drive, Tampa, FL, 33606 |
| Name | Role | Address |
|---|---|---|
| Obregon Deanna S | Chief Executive Officer | 4422 E. Columbus Drive, Tampa, FL, 33605 |
| Name | Role | Address |
|---|---|---|
| TBD TBD V | Chief Financial Officer | 4422 East Columbus Drive, Tampa, FL, 33605 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000017092 | COVE BEHAVIORAL HEALTH | ACTIVE | 2021-02-04 | 2026-12-31 | No data | 4422 EAST COLUMBUS DRIVE, TAMPA, FL, 33605 |
| G09000165088 | DACCO | EXPIRED | 2009-10-14 | 2024-12-31 | No data | 4422 E. COLUMBUS DR., TAMPA, FL, 33605 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2021-06-09 | COVE BEHAVIORAL HEALTH, INC. | No data |
| AMENDMENT | 2020-04-27 | No data | No data |
| NAME CHANGE AMENDMENT | 2017-07-21 | DACCO BEHAVIORAL HEALTH, INC. | No data |
| AMENDMENT | 2014-04-22 | No data | No data |
| AMENDMENT | 2012-08-10 | No data | No data |
| CANCEL ADM DISS/REV | 2003-11-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2003-09-19 | No data | No data |
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 1994-09-23 | DRUG ABUSE COMPREHENSIVE COORDINATING OFFICE, INC. | No data |
| REINSTATEMENT | 1986-04-10 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1983-11-10 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
