| Entity Name: | SUNCOAST HOSPICE OF HILLSBOROUGH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 17 Oct 2019 (5 years ago) |
| Document Number: | L19000250934 |
| FEI/EIN Number | 30-0845043 |
| Address: | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Mail Address: | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457002966 | 2022-01-17 | 2024-03-06 | 5771 ROOSEVELT BLVD, CLEARWATER, FL, 337603407, US | 422 S KINGS AVE, BRANDON, FL, 335115920, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-651-7300 |
| Fax | 7275234110 |
Authorized person
| Name | SAIDA BOUHAMID |
| Role | CFO |
| Phone | 9415527500 |
Taxonomy
| Taxonomy Code | 2080H0002X - Pediatric Hospice and Palliative Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 115218501 |
| State | FL |
| Issuer | MEDICAID |
| Number | 115218500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HENDRICKS, CHRISTY | Agent | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL 34202 |
| Name | Role | Address |
|---|---|---|
| FLEECE, JONATHAN D | CEO and President | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL 34202 |
| Name | Role | Address |
|---|---|---|
| BOUHAMID, SAIDA | Chief Financial Officer | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL 34202 |
| Name | Role | Address |
|---|---|---|
| HENDRICKS, CHRISTY | Chief Learning Officer | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL 34202 |
| Name | Role | Address |
|---|---|---|
| PINZON, MARIA | Director | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| GAINES, MICHAEL | Director | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| DOBBS, DEBRA, Phd | Director | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| RUPPAL, MICHAEL | Director | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Etten, Mary Jean, EdD | Director | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Name | Role | Address |
|---|---|---|
| GAINES, MICHAEL | CHAIR | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Name | Role | Address |
|---|---|---|
| COTTONE , JOYCE | VICE CHAIR D | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Name | Role | Address |
|---|---|---|
| PINZON, MARIA | Secretary | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Name | Role | Address |
|---|---|---|
| Long, Christine | Treasurer | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL 33760-3413 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000041558 | EMPATH HOSPICE OF PASCO | ACTIVE | 2024-03-25 | 2029-12-31 | No data | 5771 ROOSEVELT BLVD 610, CLEARWATER, FL, 33760 |
| G21000129981 | EMPATH SUNCOAST HOSPICE OF HILLSBOROUGH | ACTIVE | 2021-09-28 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 33760 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-25 | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL 34202 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-28 | HENDRICKS, CHRISTY | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| AMENDED ANNUAL REPORT | 2023-10-24 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-03-17 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-20 |
| Florida Limited Liability | 2019-10-17 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
