| Entity Name: | MARY WELSH FOUNDATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Nov 2016 (8 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 13 Jan 2025 (11 days ago) |
| Document Number: | N16000011478 |
| FEI/EIN Number | 81-5343772 |
| Address: | 505 N Broadway Ave, SUITE 107, Bartow, FL 33830 |
| Mail Address: | 505 N Broadway Ave, SUITE 107, Bartow, FL 33830 |
| ZIP code: | 33830 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376055400 | 2017-10-30 | 2018-01-09 | 400 E MARTIN LUTHER KING BLVD STE 107, TAMPA, FL, 336033866, US | 400 E MARTIN LUTHER KING BLVD STE 107, TAMPA, FL, 336033866, US | |||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||
| Phone | +1 813-442-7505 |
Authorized person
| Name | MS. ROBIN FOSTER |
| Role | CHAIRMAN OF THE BOARD |
| Phone | 8134427505 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 012188500 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012188500 |
| State | FL |
| Name | Role |
|---|---|
| SHELDON D. MCMULLEN, P.A. | Agent |
| Name | Role | Address |
|---|---|---|
| SKELLEY, BEVERLY | SECRETARY | 17107 DOWNS ROAD, ODESSSA, FL 33556 |
| WARNER, DANIELLE | SECRETARY | 3574 CALLE PALMITO, CARLSBAD, CA 92009 |
| Name | Role | Address |
|---|---|---|
| SKELLEY, BEVERLY | FINANCIAL OFFICER | 17107 DOWNS ROAD, ODESSSA, FL 33556 |
| WARNER, DANIELLE | FINANCIAL OFFICER | 3574 CALLE PALMITO, CARLSBAD, CA 92009 |
| Name | Role | Address |
|---|---|---|
| BEBNOWSKI, KAREN | PRESIDENT | 1421 CLARION DRIVE, VALRICO, FL 33596 |
| Name | Role | Address |
|---|---|---|
| BEBNOWSKI, KAREN | OPERATION DIRECTOR | 1421 CLARION DRIVE, VALRICO, FL 33596 |
| Name | Role | Address |
|---|---|---|
| NOLES, CARL | Vice President | 4209 SYLVAN RD., EVART, MI 49631 |
| Name | Role | Address |
|---|---|---|
| MACKEN, ELIZABETH | TREASURER | 27322 MISTFLOWER DR, WESLEY CHAPEL, FL 33544 |
| Name | Role | Address |
|---|---|---|
| FOSTER, ROBIN | CHAIRMAN | 4826 CHEVAL BLVD., LUTZ, FL 33558 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000144279 | SOLUTIONS COUNSELING CENTER OF TAMPA | ACTIVE | 2021-10-27 | 2026-12-31 | No data | 4826 CHEVAL BLVD., TAMPA, FL, 33558 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2025-01-13 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-05-02 | 4816 W. GANDY BLVD., TAMPA, FL 33611 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-05-02 | SHELDON D. MCMULLEN, P.A. | No data |
| AMENDMENT | 2021-10-12 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-24 | 505 N Broadway Ave, SUITE 107, Bartow, FL 33830 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-24 | 505 N Broadway Ave, SUITE 107, Bartow, FL 33830 | No data |
| REINSTATEMENT | 2018-03-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| NAME CHANGE AMENDMENT | 2017-03-16 | MARY WELSH FOUNDATION, INC. | No data |
| Name | Date |
|---|---|
| Amendment | 2025-01-13 |
| Reg. Agent Change | 2024-05-02 |
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-04-10 |
| ANNUAL REPORT | 2022-03-12 |
| Amendment | 2021-10-12 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-05-04 |
| ANNUAL REPORT | 2019-04-24 |
| REINSTATEMENT | 2018-03-22 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
