| Entity Name: | TRI-COUNTY HUMAN SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 22 Oct 1976 (48 years ago) |
| Document Number: | 737117 |
| FEI/EIN Number | 591708182 |
| Address: | 2026 Crystal Wood Drive, LAKELAND, FL, 33801-6884, US |
| Mail Address: | 2026 Crystal Wood Drive, LAKELAND, FL, 33801-6884, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164485074 | 2006-04-11 | 2024-10-16 | 2026 CRYSTAL WOOD DR, LAKELAND, FL, 338016884, US | 2340 COMMERCE POINT DR, LAKELAND, FL, 338016880, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 863-709-9392 |
| Fax | 8637098923 |
| Phone | +1 863-709-8543 |
Authorized person
| Name | BECKY RAZAIRE |
| Role | ADMIN DIRECTOR |
| Phone | 8638999538 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | Yes |
| Taxonomy Code | 261QC1500X - Community Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QM0855X - Adolescent and Children Mental Health Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 060397000 |
| State | FL |
| LEI number | Registered As | Jurisdiction Of Formation | General Category | Entity Status | Entity created at | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 549300ESSQMZM451P673 | 737117 | US-FL | GENERAL | ACTIVE | No data | |||||||||||||||||||
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| Legal | C/O Cuniff, Linda, 1012 North Riverdale Road, Avon Park, US-FL, US, 33825 |
| Headquarters | 1815 Crystal Lake Drive, Lakeland, US-FL, US, 33801 |
Registration details
| Registration Date | 2015-02-14 |
| Last Update | 2023-08-04 |
| Status | LAPSED |
| Next Renewal | 2016-02-12 |
| LEI Issuer | 5493001KJTIIGC8Y1R12 |
| Corroboration Level | FULLY_CORROBORATED |
| Data Validated As | 737117 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TRI-COUNTY HUMAN SERVICES, INC. HEALTH BENEFIT PLAN | 2021 | 591708182 | 2022-07-19 | TRI-COUNTY HUMAN SERVICES, INC. | 201 | |||||||||||||||||
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| Active participants | 216 |
| File | View Page |
| Three-digit plan number (PN) | 502 |
| Effective date of plan | 1992-12-01 |
| Business code | 624100 |
| Plan sponsor’s mailing address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
| Plan sponsor’s address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
Number of participants as of the end of the plan year
| Active participants | 201 |
| File | View Page |
| Three-digit plan number (PN) | 502 |
| Effective date of plan | 1992-12-01 |
| Business code | 624100 |
| Plan sponsor’s mailing address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
| Plan sponsor’s address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
Number of participants as of the end of the plan year
| Active participants | 222 |
| File | View Page |
| Three-digit plan number (PN) | 502 |
| Effective date of plan | 1992-12-01 |
| Business code | 624100 |
| Sponsor’s telephone number | 8637099392 |
| Plan sponsor’s mailing address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
| Plan sponsor’s address | 1815 CRYSTAL LAKE DRIVE, LAKELAND, FL, 338015979 |
Number of participants as of the end of the plan year
| Active participants | 172 |
| Name | Role | Address |
|---|---|---|
| Battle Leon | Agent | 2026 Crystal Wood Drive, LAKELAND, FL, 338016884 |
| Name | Role | Address |
|---|---|---|
| Idell Jennifer | Treasurer | 856 Twin Oaks Lane, Winter Haven, FL, 33880 |
| Name | Role | Address |
|---|---|---|
| Phillips Tina | Director | 4255 Stafford Drive, Winter Haven, FL, 338801142 |
| Vinesett Linda | Director | 2500 Laurel Glen Drive, Lakeland, FL, 33803 |
| Name | Role | Address |
|---|---|---|
| Rihn Robert C | Chief Executive Officer | 1815 Crystal Lake Drive, Lakeland, FL, 338015979 |
| Name | Role | Address |
|---|---|---|
| Beatty Brad | Vice Chairman | 137 Lake Otis Road, Winter Haven, FL, 33884 |
| Name | Role | Address |
|---|---|---|
| Battle Leon | Chairman | 1015 Sikes Blvd., LAKELAND, FL, 33815 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000071356 | MEADOWBROOK PSYCHIATRIC AND COUNSELING CENTRE | EXPIRED | 2019-06-26 | 2024-12-31 | No data | 1409 MEADOWBROOK AVENUE, LAKELAND, FL, 33803 |
| G11000046103 | TRI COUNTY HUMAN SERVICES INC. | EXPIRED | 2011-05-13 | 2016-12-31 | No data | 1815 CRYSTAL LAKE DR, LAKELAND, FL, 33801 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES/NAME CHANGE | 1997-11-14 | TRI-COUNTY HUMAN SERVICES, INC. | No data |
| AMENDED AND RESTATEDARTICLES | 1985-11-21 | No data | No data |
| NAME CHANGE AMENDMENT | 1985-11-21 | TRI-COUNTY ADDICTIONS REHABILITATION SERVICES, INC. | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
