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WILLOUGH HEALTHCARE, INC.

WILLOUGH HEALTHCARE, INC.

Company Details

Entity Name:	WILLOUGH HEALTHCARE, INC.
Jurisdiction:	FLORIDA
Filing Type:	Domestic Profit
Status:	Active
Date Filed:	04 Apr 1984 (41 years ago)
Document Number:	G94649
FEI/EIN Number	592401831
Mail Address:	201 N. Franklin Street, Suite 1910, TAMPA, FL, 33602, US
Address:	201 N. Franklin Street, Suite 1910, Tampa, FL, 33602, US
ZIP code:	33602
County:	Hillsborough
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1932138823

2006-07-02

2024-11-06

7074 GROVE RD # 129, BROOKSVILLE, FL, 346098658, US

9001 TAMIAMI TRL E, NAPLES, FL, 341133304, US

Contacts

Phone	+1 813-978-1933
Fax	3526109996
Phone	+1 239-775-4500
Fax	2397552990

Authorized person

Name	TRACY ROBERTS
Role	DIRECTOR REVENUE CYCLE MANAGEMENT
Phone	4238950084

Taxonomy

Taxonomy Code	283Q00000X - Psychiatric Hospital
License Number	4212
State	FL
Is Primary	Yes

form 5500

Plan Name

Plan Year

EIN/PN

Received

Sponsor

Total number of participants

WILLOUGH HEALTHCARE INC. 401(K) RETIREMENT PLAN

2009

592401831

2012-10-23

WILLOUGH HEALTHCARE INC.

130

File	View Page
Three-digit plan number (PN)	001
Effective date of plan	2003-01-01
Business code	622000
Sponsor’s telephone number	8139781933
Plan sponsor’s mailing address	15310 AMBERLY DRIVE, SUITE 300, TAMPA, FL, 33647
Plan sponsor’s address	15310 AMBERLY DRIVE, SUITE 300, TAMPA, FL, 33647

Plan administrator’s name and address

Administrator’s EIN	592401831
Plan administrator’s name	WILLOUGH HEALTHCARE INC.
Plan administrator’s address	15310 AMBERLY DRIVE, SUITE 300, TAMPA, FL, 33647
Administrator’s telephone number	8139781933

Number of participants as of the end of the plan year

Active participants	0
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

Signature of

Role	Plan administrator
Date	2012-10-23
Name of individual signing	WARREN KNIGHT
Valid signature	Filed with authorized/valid electronic signature

Agent

Name	Role	Address
Raymond J. P	Agent	625 Court Street, Clearwater, FL, 33756

President

Name	Role	Address
PICCIANO JOHN R	President	201 N FRANKLIN ST #1910, TAMPA, FL, 33602

Director

Name	Role	Address
PICCIANO JOHN R	Director	201 N FRANKLIN ST #1910, TAMPA, FL, 33602
O'SHEA JAMES	Director	201 N FRANKLIN ST #1910, TAMPA, FL, 33602
COHEN ROBERT M	Director	201 N FRANKLIN ST #1910, TAMPA, FL, 33602

Secretary

Name	Role	Address
O'SHEA JAMES	Secretary	201 N FRANKLIN ST #1910, TAMPA, FL, 33602

Fictitious Names

Registration Number	Fictitious Name	Status	Filed Date	Expiration Date	Cancellation Date	Mailing Address
G23000133270	THE WILLOUGH AT NAPLES	ACTIVE	2023-10-30	2028-12-31	No data	13406 CORTEZ BLVD, BROOKSVILLE, FL, 34613

Events

Event Type	Filed Date	Value	Description
AMENDMENT	2020-11-23	No data	No data
AMENDMENT	2009-10-23	No data	No data
CANCEL ADM DISS/REV	2004-10-20	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	2004-10-01	No data	No data
NAME CHANGE AMENDMENT	1995-05-23	WILLOUGH HEALTHCARE, INC.	No data
REINSTATEMENT	1985-12-09	No data	No data
INVOLUNTARILY DISSOLVED	1985-11-01	No data	No data
NAME CHANGE AMENDMENT	1984-05-07	NAPLES RESEARCH & COUNSELING CENTER, INC.	No data

Date of last update: 03 Jan 2025

Sources: Florida Department of State