| Entity Name: | BREVARD COMMUNITY HEALTH SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 16 Sep 2009 (15 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | N09000009073 |
| FEI/EIN Number | 270981625 |
| Address: | 2226 SARNO ROAD, SUITE 111, MELBOURNE, FL, 32935, US |
| Mail Address: | 2226 SARNO ROAD, SUITE 111, MELBOURNE, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184952236 | 2009-12-01 | 2009-12-01 | 2226 SARNO RD STE 111, MELBOURNE, FL, 329353087, US | 2226 SARNO RD STE 111, MELBOURNE, FL, 329353087, US | |||||||||||||||||||||
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| Phone | +1 321-751-6390 |
| Fax | 3217516389 |
Authorized person
| Name | MR. AL O'CONNELL |
| Role | PRESIDENT |
| Phone | 3217254500 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE IDENTIFICATION NUMBER |
| Number | 108053 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| O'CONNELL AL | Agent | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| GURRI JOSEPH A | Director | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| MARZANO PETER D | Director | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| MCCLURE JOSEPH A | Director | 1130 HICKORY STREET, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| NESCIO RICH T | Manager | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| O'CONNELL AL P | Manager | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| JOHANSEN DEBRA A | Manager | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000180794 | COMMUNITY HOMECARE | EXPIRED | 2009-12-03 | 2014-12-31 | No data | 2226 SARNO ROAD, SUITE 111, MELBOURNE, FL, 32935 |
| G09000167460 | MIMA HOMECARE | EXPIRED | 2009-10-21 | 2014-12-31 | No data | 1223 GATEWAY DRIVE, MELBOURNE, FL, 32901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-04-28 | 2226 SARNO ROAD, SUITE 111, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-28 | 2226 SARNO ROAD, SUITE 111, MELBOURNE, FL 32935 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-04-28 |
| Domestic Non-Profit | 2009-09-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
