| Entity Name: | AGENCY FOR COMMUNITY TREATMENT SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 02 Nov 1978 (46 years ago) |
| Document Number: | 744798 |
| FEI/EIN Number | 591860626 |
| Address: | 3450 Buschwood Park Dr., TAMPA, FL, 33618, US |
| Mail Address: | 3450 Buschwood Park Dr., TAMPA, FL, 33618, US |
| ZIP code: | 33618 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073883534 | 2011-12-30 | 2022-10-19 | 4612 N 56TH ST, TAMPA, FL, 336107123, US | 4612 N 56TH ST, TAMPA, FL, 336107123, US | |||||||||||||||||||||||||||||
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| Phone | +1 813-248-4899 |
| Fax | 8133672312 |
| Phone | +1 813-246-4899 |
| Fax | 8133672579 |
Authorized person
| Name | ASHA PEREYRA |
| Role | CEO |
| Phone | 8132484899 |
Taxonomy
| Taxonomy Code | 251V00000X - Voluntary or Charitable Agency |
| License Number | IMH9474 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 060556500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AGENCY FOR COMMUNITY TREATMENT SERVICES INC. HEALTH AND WELFARE PLAN | 2018 | 591860626 | 2019-05-14 | AGENCY FOR COMMUNITY TREATMENT SERVICES | 140 | |||||||||||||||||||||||||||
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| Active participants | 140 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| File | View Page |
| Three-digit plan number (PN) | 501 |
| Effective date of plan | 2017-01-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 8132464899 |
| Plan sponsor’s mailing address | 4612 N 56TH ST, TAMPA, FL, 336107123 |
| Plan sponsor’s address | 4612 N 56TH ST, TAMPA, FL, 336107123 |
Number of participants as of the end of the plan year
| Active participants | 137 |
| Retired or separated participants receiving benefits | 0 |
| Other retired or separated participants entitled to future benefits | 0 |
| Deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 0 |
| Number of participants with account balances as of the end of the plan year | 0 |
| Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 0 |
| Name | Role | Address |
|---|---|---|
| Pereyra Asha | Agent | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| Mazza Patrick | President | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| Parsons Cindy | Secretary | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| Ennis Gary | Director | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Paulk Jeff | Director | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| HIRSCH WILLIAM | Treasurer | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Name | Role | Address |
|---|---|---|
| Carter Sharon | Vice President | 3450 Buschwood Park Dr., TAMPA, FL, 33618 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000005925 | ACTS ADULT RESIDENTIAL TREATMENT SERVICES AT NEBRASKA | ACTIVE | 2023-01-12 | 2028-12-31 | No data | 6806 N NEBRASKA AVENUE, TAMPA, FL, 33604 |
| G22000116328 | ACTS THERAPEUTIC GROUP HOME | ACTIVE | 2022-09-15 | 2027-12-31 | No data | 4612 N 56TH STREET, TAMPA, FL, 33610 |
| G22000058059 | ACTS THERAPEUTIC GROUP HOME | ACTIVE | 2022-05-08 | 2027-12-31 | No data | 8620 N DIXON AVE, TAMPA, FL, 33604 |
| G21000030529 | ACTS 131ST AVE INTERMEDIATE CARE PROGRAM | ACTIVE | 2021-03-04 | 2026-12-31 | No data | 1229 E. 131ST AVENUE, TAMPA, FL, 33612 |
| G21000001805 | ACTS JUVENILE ADDICTIONS RECEIVING FACILITY | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 8620 N. DIXON AVE, TAMPA, FL, 33614 |
| G21000001792 | ACTS ADULT ADDICTIONS RECEIVING FACILITY | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 2214 EAST HENRY AVENUE, TAMPA, FL, 33610 |
| G21000001799 | ACTS ADULT RESIDENTIAL TREATMENT SERVICES AT DREW PARK | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 4403 W. DR MARTIN LUTHER KING BLVD., TAMPA, FL, 33614 |
| G21000001802 | ACTS ADOLESCENT RESIDENTIAL TREATMENT SERVICES AT THONOTOSASSA | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 11309 TOM FOLSOM RD, THONOTOSASSA, FL, 33592 |
| G21000001812 | ACTS ADOLESCENT RESIDENTIAL TREATMENT SERVICES AT FT LAUDERDALE | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 1048 NE 3RD AVE, FORT LAUDERDALE, FL, 33304 |
| G21000001816 | ACTS ADULT RESIDENTIAL TREATMENT SERVICES AT KEYSTONE | ACTIVE | 2021-01-05 | 2026-12-31 | No data | 3575 OLD KEYSTONE RD, TARPON SPRINGS, FL, 33869 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2019-06-03 | No data | No data |
| AMENDMENT | 2015-02-12 | No data | No data |
| AMENDMENT | 2014-08-21 | No data | No data |
| AMENDMENT | 2013-04-04 | No data | No data |
| AMENDMENT AND NAME CHANGE | 1991-06-21 | AGENCY FOR COMMUNITY TREATMENT SERVICES, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
