| Entity Name: | HIDDEN POTENTIAL FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 04 Sep 2019 (5 years ago) |
| Document Number: | L19000224357 |
| FEI/EIN Number | 84-3109457 |
| Address: | 2859 SOUTH BUMBY AVENUE, ORLANDO, FL, 32806, US |
| Mail Address: | PO BOX 844, WINTER PARK, FL, 32790 |
| ZIP code: | 32806 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508404211 | 2019-12-12 | 2019-12-12 | PO BOX 844, WINTER PARK, FL, 32790, US | 2857 SOUTH BUMBY AVENUE, ORLANDO, FL, 32806, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 407-800-7711 |
| Fax | 4073176571 |
Authorized person
| Name | JENNIFER L BLAIR |
| Role | OWNER |
| Phone | 4078007711 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | Yes |
| Taxonomy Code | 106E00000X - Assistant Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 14230101 |
| State | FL |
| Issuer | MEDICAID |
| Number | 018010800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TWYFORD PAUL D | Agent | 2859 SOUTH BUMBY AVENUE, ORLANDO, FL, 32806 |
| Name | Role | Address |
|---|---|---|
| TWYFORD PAUL D | Manager | 2857 SOUTH BUMBY AVENUE, ORLANDO, FL, 32806 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-28 | 2859 SOUTH BUMBY AVENUE, ORLANDO, FL 32806 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-04-28 | 2859 SOUTH BUMBY AVENUE, ORLANDO, FL 32806 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-05-01 |
| ANNUAL REPORT | 2021-05-13 |
| ANNUAL REPORT | 2020-06-23 |
| Florida Limited Liability | 2019-09-04 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
