| Entity Name: | CREW COMMUNITY HEALTH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 27 Feb 2020 (5 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 08 Nov 2021 (3 years ago) |
| Document Number: | N20000002360 |
| FEI/EIN Number | 84-4928742 |
| Address: | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Mail Address: | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| ZIP code: | 32819 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1093356842 | 2019-10-03 | 2024-02-06 | 8601 COMMODITY CIRCLE, ORLANDO, FL, 32819, US | 8601 COMMODITY CIRCLE, ORLANDO, FL, 32819, US | |||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 407-605-2253 |
| Fax | 8557503960 |
| Phone | +1 407-605-2252 |
Authorized person
| Name | MR. STERLING BRODNIAK |
| Role | MEDICAL DIRECTOR |
| Phone | 4076052253 |
Taxonomy
| Taxonomy Code | 103T00000X - Psychologist |
| Is Primary | No |
| Taxonomy Code | 207RI0200X - Infectious Disease Physician |
| Is Primary | Yes |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113976900 |
| State | FL |
| Name | Role |
|---|---|
| CREW COMMUNITY HEALTH, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| MURGASEN, EDDIE IRFAN, Dr. | Interim Board Chair | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| AYYASH, AHMAD | Director | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| FRANCIS, KBF, Phd | Director | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| SANFORD-WETHERELL, AARON | Vice Chairman | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ, DAVID | Treasurer | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819-0000 |
| Name | Role | Address |
|---|---|---|
| ACUFF, BRITTANI | Interim CEO | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| ACUFF, BRITTANI | President | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Name | Role | Address |
|---|---|---|
| MARTINEZ, OMAR | Secretary | 8601 COMMODITY CIRCLE, ORLANDO, FL 32819 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G23000046543 | CREW HEALTH | ACTIVE | 2023-04-12 | 2028-12-31 | No data | 8601 COMMODITY CIRCLE, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-07-23 | Crew Community Health | No data |
| AMENDMENT | 2021-11-08 | No data | No data |
| AMENDMENT | 2021-03-22 | No data | No data |
| AMENDMENT | 2020-09-11 | No data | No data |
| AMENDMENT | 2020-05-29 | No data | No data |
| AMENDMENT | 2020-04-30 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-12-10 |
| AMENDED ANNUAL REPORT | 2024-11-06 |
| AMENDED ANNUAL REPORT | 2024-09-19 |
| ANNUAL REPORT | 2024-04-30 |
| AMENDED ANNUAL REPORT | 2023-09-26 |
| AMENDED ANNUAL REPORT | 2023-07-23 |
| AMENDED ANNUAL REPORT | 2023-06-30 |
| AMENDED ANNUAL REPORT | 2023-05-26 |
| ANNUAL REPORT | 2023-05-18 |
| ANNUAL REPORT | 2022-01-31 |
Date of last update: 16 Jan 2025
Sources: Florida Department of State
