| Entity Name: | ADVANCE REHAB & HOME HEALTH LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 01 Jun 2005 (20 years ago) |
| Document Number: | L05000054157 |
| FEI/EIN Number | 20-2945722 |
| Address: | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 |
| Mail Address: | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003835026 | 2006-07-19 | 2021-03-15 | 2316 W 23RD ST STE B, PANAMA CITY, FL, 324052373, US | 2316 W 23RD ST STE B, PANAMA CITY, FL, 324052373, US | |||||||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||||||
| Phone | +1 850-522-4770 |
| Fax | 8505224760 |
Authorized person
| Name | MR. MOHAMED HUSSEIN |
| Role | OWNER |
| Phone | 8505224770 |
Taxonomy
| Taxonomy Code | 225100000X - Physical Therapist |
| License Number | PT8384 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS OF FL |
| Number | Q6A |
| State | FL |
| Issuer | MEDICAID |
| Number | 891217300 |
| State | FL |
| Issuer | Y6894 |
| Number | BCBS INDUVIDUAL NUMB |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HUSSEIN, MOHAMED | Agent | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 |
| Name | Role | Address |
|---|---|---|
| HUSSEIN, MOHAMED | Managing Member | 2316 W. 23RD STREET, B PANAMA CITY, FL 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-03-07 | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2019-03-07 | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-07 | 2316 W. 23RD STREET, B, PANAMA CITY, FL 32405 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-02-05 |
| ANNUAL REPORT | 2019-03-07 |
| ANNUAL REPORT | 2018-03-10 |
| ANNUAL REPORT | 2017-01-11 |
| ANNUAL REPORT | 2016-01-14 |
| ANNUAL REPORT | 2015-01-14 |
Date of last update: 28 Jan 2025
Sources: Florida Department of State
