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INTEGRATED HEALTHCARE SYSTEMS RIVIERA, INC - Florida Company Profile

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Company Details

Entity Name: INTEGRATED HEALTHCARE SYSTEMS RIVIERA, INC
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active
Date Filed: 12 May 2020 (5 years ago)
Last Event: NAME CHANGE AMENDMENT
Event Date Filed: 22 May 2023 (2 years ago)
Document Number: N20000005065
FEI/EIN Number 851003540
Address: 800 N SAPODILLA AVENUE #3, West Palm Beach, FL, 33401, US
Mail Address: 800 N SAPODILLA AVENUE #3, West Palm Beach, FL, 33401, US
ZIP code: 33401
City: West Palm Beach
County: Palm Beach
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
- Agent -
BROCKETT CLARENCE Treasurer 504 WOODBINE WAY, SUITE 504, PALM BEACH GARDENS, FL, 33418
Spencer Alia Secretary 3200 Summit Blvd, West Palm Beach, FL, 33416
KOLMAN STEVE President PO BOX 9370, RIVIERA BEACH, FL, 33419
Brown Faust Monique DPhd Exec 31 W 20TH STREET, RIVIERA BEACH, FL, 33404
Lewis Diane DTH Director 3437 Avenue O, Riviera Beach, FL, 33404
Evans Richard Director 31 W 20th Street, Riviera Beach, FL, 33404

Unique Entity ID

Unique Entity ID:
X949NGDMNDZ6
CAGE Code:
9XR92
UEI Expiration Date:
2026-05-19

Business Information

Activation Date:
2025-05-21
Initial Registration Date:
2024-05-04

Commercial and government entity program

CAGE number:
9XR92
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2025-05-21
CAGE Expiration:
2030-05-21
SAM Expiration:
2026-05-19

Contact Information

POC:
MONIQUE D. BROWN FAUST

National Provider Identifier

NPI Number:
1053092148
Certification Date:
2023-07-27

Authorized Person:

Name:
MONIQUE D BROWN FAUST
Role:
EXECUTIVE DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
2084P0800X - Psychiatry Physician
Is Primary:
No
Selected Taxonomy:
251B00000X - Case Management Agency
Is Primary:
No
Selected Taxonomy:
261Q00000X - Clinic/Center
Is Primary:
No
Selected Taxonomy:
251S00000X - Community/Behavioral Health Agency
Is Primary:
Yes

Contacts:

Fax:
5613312715

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G23000088352 INTEGRATED HEALTHCARE SYSTEMS ACTIVE 2023-07-27 2028-12-31 - 31 W 20TH STREET, SUITE 100, RIVIERA BEACH, FL, 33404
G22000075365 INTEGRATED HEALTH CARE FOR DACOSTA YOUTH AND FAMILY ACTIVE 2022-06-22 2027-12-31 - 31 W 20TH STREET, SUITE 400, RIVIERA BEACH, FL, 33404
G21000117840 INTEGRATED HEALTHCARE SYSTEMS ACTIVE 2021-09-14 2026-12-31 - 31 W 20TH STREET, 200, RIVIERA BEACH, FL, 33404
G21000049256 INTEGRATED HEALTH SYSTEMS ACTIVE 2021-04-10 2026-12-31 - 31 W 20TH STREET, SUITE 100, RIVIERA BEACH, FL, 33404

Events

Event Type Filed Date Value Description
NAME CHANGE AMENDMENT 2023-05-22 INTEGRATED HEALTHCARE SYSTEMS RIVIERA, INC -
AMENDMENT 2020-06-29 - -

Documents

Name Date
ANNUAL REPORT 2024-04-28
Name Change 2023-05-22
ANNUAL REPORT 2023-04-28
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-03-18
Amendment 2020-06-29
Domestic Non-Profit 2020-05-12

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Date of last update: 02 Aug 2025

Sources: Florida Department of State