| Entity Name: | HALIFAX HOSPICE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 21 Dec 1984 (40 years ago) |
| Document Number: | N06783 |
| FEI/EIN Number | 592661284 |
| Address: | 3800 WOODBRIAR TRAIL, PORT ORANGE, FL, 32119, US |
| Mail Address: | 303 N. CLYDE MORRIS BLVD., ATTN: LEGAL DEPT., DAYTONA BEACH, FL, 32114, US |
| ZIP code: | 32119 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376510065 | 2006-03-02 | 2011-04-14 | 3800 WOODBRIAR TRAIL, PORT ORANGE, FL, 321299626, US | 3800 WOODBRIAR TRAIL, PORT ORANGE, FL, 321299626, US | |||||||||||||||||||||||||
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| Phone | +1 386-322-4701 |
| Fax | 3863224702 |
Authorized person
| Name | MRS. FRANCES F DAVIS |
| Role | EXECUTIVE DIRECTOR |
| Phone | 3863224701 |
Taxonomy
| Taxonomy Code | 251G00000X - Community Based Hospice Care Agency |
| License Number | 5034096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 087523600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KWIATEK KELLY | Agent | 303 N. CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| RITCHEY GLENN | Director | 551 NORTH NOVA ROAD, DAYTONA BEACH, FL, 32114 |
| GOODEMOTE HAROLD | Director | 619 NORTH BEACH STREET, DAYTONA BEACH, FL, 32114 |
| MCCALL TOM | Director | 2379 BEVILLE ROAD, DAYTONA BEACH, FL, 32119 |
| LENTZ CARL WIII | Director | 570 John Anderson Drive, Ormond Beach, FL, 32176 |
| Florez Alan | Director | 225 Landmark Cr., Ormond Beach, FL, 32176 |
| Name | Role | Address |
|---|---|---|
| FEASEL JEFF | President | 303 NORTH CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000104434 | HALIFAX HEALTH HOSPICE | ACTIVE | 2014-10-15 | 2029-12-31 | No data | 3800 WOODBRIAR TRAIL, PORT ORANGE, FL, 32129 |
| G09000106894 | LAWRENCE E. WHELAN BEGINAGAIN CHILDREN'S GRIEF CENTER | ACTIVE | 2009-05-13 | 2029-12-31 | No data | C/O LEGAL DEPARTMENT, 303 NORTH CLYDE MORRIS BOULEVARD, DAYTONA BEACH, FL, 32114 |
| G08121700057 | HALIFAX HEALTH HOSPICE OF VOLUSIA/FLAGLER | ACTIVE | 2008-04-30 | 2028-12-31 | No data | 303 NORTH CLYDE MORRIS BOULEVARD, DAYTONA BEACH, FL, 32114 |
| G04245700058 | FAMILY CAREGIVER PROGRAM | ACTIVE | 2004-09-01 | 2029-12-31 | No data | C/O HMC LEGAL DEPARTMENT, 303 N. CLYDE MORRIS, DAYTONA BEACH, FL, 32114 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2009-09-11 | No data | No data |
| REINSTATEMENT | 1987-12-15 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1987-11-16 | No data | No data |
| AMENDMENT | 1987-06-25 | No data | No data |
| AMENDMENT | 1985-09-04 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
