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REGENCY HOSPICE OF NORTHWEST FLORIDA, INC. - Florida Company Profile

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Company Details

Entity Name: REGENCY HOSPICE OF NORTHWEST FLORIDA, INC.
Jurisdiction: FLORIDA
Filing Type: Foreign Profit
Status: Active
Date Filed: 31 May 2012 (13 years ago)
Last Event: CONVERSION
Event Date Filed: 31 May 2012 (13 years ago)
Document Number: F12000002301
FEI/EIN Number 26-3437769
Address: 655 Brawley School Road, Suite 200, Mooresville, NC, 28117, US
Mail Address: 655 Brawley School Road, Suite 200, Mooresville, NC, 28117, US
Place of Formation: DELAWARE

Key Officers & Management

Name Role Address
Causby David President 655 Brawley School Road, Mooresville, NC, 28117
Combs Janet Vice President 655 Brawley School Road, Mooresville, NC, 28117
Lazas Ronald CJr. Director 655 Brawley School Road, Mooresville, NC, 28117
Lazas Ronald Jr. Gene 655 Brawley School Road, Mooresville, NC, 28117
CT CORPORATION SYSTEM Agent 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL, 33324
Dolan Thomas J Chief Financial Officer 655 Brawley School Road, Mooresville, NC, 28117
Arnold David Vice President 655 Brawley School Road, Mooresville, NC, 28117

National Provider Identifier

NPI Number:
1730326828
Certification Date:
2023-01-17

Authorized Person:

Name:
MS. JANET COMBS
Role:
VP OF LICENSURE
Phone:

Taxonomy:

Selected Taxonomy:
251G00000X - Community Based Hospice Care Agency
Is Primary:
Yes

Contacts:

Fax:
8504789481

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000113817 GENTIVA 1 ACTIVE 2022-09-12 2027-12-31 - 1045 US HWY 331 SOUTH, UNIT C, DEFUNIAK SPRINGS, FL, 32435
G13000124497 REGENCY HOSPICE EXPIRED 2013-12-19 2018-12-31 - 491 WILLIAMSON ROAD, STE. 204, MOORSEVILLE, NC, 28117

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-05-01 655 Brawley School Road, Suite 200, Mooresville, NC 28117 -
CHANGE OF MAILING ADDRESS 2024-05-01 655 Brawley School Road, Suite 200, Mooresville, NC 28117 -
REGISTERED AGENT NAME CHANGED 2012-06-27 CT CORPORATION SYSTEM -
REGISTERED AGENT ADDRESS CHANGED 2012-06-27 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 -
CONVERSION 2012-05-31 - CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P06000150077. CONVERSION NUMBER 300000123093

Documents

Name Date
ANNUAL REPORT 2024-05-01
ANNUAL REPORT 2023-04-28
ANNUAL REPORT 2022-04-26
AMENDED ANNUAL REPORT 2021-08-16
AMENDED ANNUAL REPORT 2021-06-29
ANNUAL REPORT 2021-04-30
ANNUAL REPORT 2020-05-19
ANNUAL REPORT 2019-03-25
ANNUAL REPORT 2018-04-02
ANNUAL REPORT 2017-04-18

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Date of last update: 01 Aug 2025

Sources: Florida Department of State