| Entity Name: | ADVENTHEALTH POLK NORTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 18 Apr 2019 (6 years ago) |
| Document Number: | N19000004061 |
| FEI/EIN Number | 84-1793121 |
| Address: | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Mail Address: | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| ZIP code: | 32714 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801457510 | 2019-06-24 | 2024-06-26 | 40100 HIGHWAY 27, DAVENPORT, FL, 338375906, US | 40100 HIGHWAY 27, DAVENPORT, FL, 338375906, US | |||||||||||||||
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| Phone | +1 863-419-2259 |
| Fax | 8634192264 |
Authorized person
| Name | ALAN JUSTIN HENGESBACH |
| Role | CFO |
| Phone | 8634192260 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Schuman, Jessica | Agent | 14055 Riveredge Dr, Suite 250, Tampa, FL 33637 |
| Name | Role | Address |
|---|---|---|
| Wandersleben, Jennifer | Chairman and Director | 14055 Riveredge Drive, Suite 250 Tampa, FL 33637 |
| Name | Role | Address |
|---|---|---|
| Addiscott, Lynn | Assistant Secretary | 900 Hope Way, Altamonte Spings, FL 32714 |
| Haney, Vincent | Assistant Secretary | 900 Hope Way, Altamonte Spings, FL 32714 |
| Graff, Jeff | Assistant Secretary | 900 Hope Way, Altamonte Spings, FL 32714 |
| Saunders, Mike | Assistant Secretary | 900 Hope Way, Altamonte Spings, FL 32714 |
| Foltz, Robert C. | Assistant Secretary | 26300 Siena Dr, Bonita Springs, FL 34134 |
| Huffman, David | Assistant Secretary | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Berrios, Toni | Assistant Secretary | 900 Hope Way, Altamonte Springs, FL 32714 |
| Banks, David | Assistant Secretary | 900 Hope Way, Altamonte Springs, FL 32714 |
| Name | Role | Address |
|---|---|---|
| Harcombe, Doug | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Hilliard, Doug | Director | 601 E Rollins St, Orlando, FL 32803 |
| Nelson, James | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Hagensicker, Janice | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Guth, Jim | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Clark, Timothy | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Dunkel, Jason | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Littleton, Greg | Director | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Bratten, Amy | Director | 999 Ave H NE, Winter Haven, FL 33881 |
| Brown, Royce | Director | 410 S 11th St, Lake Wales, FL 33853 |
| Name | Role | Address |
|---|---|---|
| BRADY, MANDY | ASSISTANT SECRETARY | 900 HOPE WAY, ALTAMONTE SPRINGS, FL 32714 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000063226 | ADVENTHEALTH WINTER HAVEN ER | ACTIVE | 2024-05-15 | 2029-12-31 | No data | 6945 CYPRESS GARDEN BLVD, WINTER HAVEN, FL, 33834 |
| G24000028401 | ADVENTHEALTH ER WINTER HAVEN | ACTIVE | 2024-02-22 | 2029-12-31 | No data | 6945 CYPRESS GARDEN BLVD, WINTER HAVEN, FL, 33834 |
| G23000126658 | ADVENTHEALTH LAB | ACTIVE | 2023-10-12 | 2028-12-31 | No data | 40100 US HIGHWAY 27, DAVENPORT, FL, 33837 |
| G23000104914 | ADVENTHEALTH ER WINTER HAVEN | ACTIVE | 2023-09-05 | 2028-12-31 | No data | 6945 CYPRESS GARDENS BLVD, WINTER HAVEN, FL, 33884 |
| G23000042943 | ADVENTHEALTH IMAGING HEART OF FLORIDA | ACTIVE | 2023-04-04 | 2028-12-31 | No data | 40100 US HWY 27, DAVENPORT, FL, 33837 |
| G23000016870 | ADVENTHEALTH WEST FLORIDA DIVISION | ACTIVE | 2023-02-03 | 2028-12-31 | No data | 14055 RIVEREDGE DR, SUITE 250, TAMPA, FL, 33637 |
| G21000056924 | ADVENTHEALTH SPORTS MED & REHAB DAVENPORT NORTH BOULEVARD | ACTIVE | 2021-04-26 | 2026-12-31 | No data | 2231 NORTH BOULEVARD WEST, SUITE B, DAVENPORT, FL, 33837 |
| G20000127031 | ADVENTHEALTH HEART SUCCESS CLINIC HEART OF FLORIDA | ACTIVE | 2020-09-30 | 2025-12-31 | No data | 40124 US HWY 127, SUITE 102, DAVENPORT, FL, 33837 |
| G19000072324 | ADVENTHEALTH WOUND CARE HAINES CITY | ACTIVE | 2019-06-28 | 2029-12-31 | No data | 280 PATTERSON ROAD, SUITE 4, HAINES CITY, FL, 33844 |
| G19000072342 | ADVENTHEALTH FOUR CORNERS ER | ACTIVE | 2019-06-28 | 2029-12-31 | No data | 17430 BALI BOULEVARD, WINTER GARDEN, FL, 34787 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-02-03 | 14055 Riveredge Dr, Suite 250, Tampa, FL 33637 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-09-09 | Schuman, Jessica | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-02 |
| AMENDED ANNUAL REPORT | 2024-09-30 |
| ANNUAL REPORT | 2024-04-23 |
| AMENDED ANNUAL REPORT | 2023-02-03 |
| ANNUAL REPORT | 2023-01-13 |
| AMENDED ANNUAL REPORT | 2022-09-09 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-21 |
| Reg. Agent Change | 2020-12-11 |
| ANNUAL REPORT | 2020-06-23 |
Date of last update: 17 Jan 2025
Sources: Florida Department of State
