| Entity Name: | AIDS SERVICE ASSOCIATION OF PINELLAS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 22 Dec 1987 (37 years ago) |
| Document Number: | N24229 |
| FEI/EIN Number | 592862537 |
| Address: | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 33760-3413, US |
| Mail Address: | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 33760-3413, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184866295 | 2009-04-03 | 2023-09-11 | 5771 ROOSEVELT BLVD, CLEARWATER, FL, 337603407, US | 5771 ROOSEVELT BLVD, CLEARWATER, FL, 337603407, US | |||||||||||||||||||||
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| Phone | +1 727-586-4432 |
| Fax | 7275233342 |
Authorized person
| Name | MARY J LABYAK |
| Role | PRESIDENT |
| Phone | 7275864432 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 672211300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HENDRICKS CHRISTY | Agent | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL, 34202 |
| Name | Role | Address |
|---|---|---|
| BUBY DAVID | Director | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 337603413 |
| FIGGS-SANDLER DEBORAH | Director | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 337603413 |
| Cohen Lisa E | Director | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 337603413 |
| GOFORTH KAREN | Director | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 337603413 |
| BRYANT CRAIG | Director | 5771 ROOSEVELT BLVD., CLEARWATER, FL, 337603413 |
| Name | Role | Address |
|---|---|---|
| FLEECE JONATHAN D | Chief Executive Officer | 6310 CAPITAL DRIVE, LAKEWOOD RANCH, FL, 34202 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000130638 | EMPATH EPIC | ACTIVE | 2021-09-29 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD., CLEARWATER, FK, 33760 |
| G21000011865 | EPIC SEXUAL HEALTH CENTER | ACTIVE | 2021-01-25 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD., #610, CLEARWATER, FL, 33760 |
| G16000132501 | ASAP CAMPUS | ACTIVE | 2016-12-09 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD, SUITE 610, CLEARWATER, FL, 33760 |
| G16000132509 | FRANCIS HOUSE CAMPUS | ACTIVE | 2016-12-09 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD, SUITE 610, CLEARWATER, FL, 33760 |
| G16000128924 | EPIC | ACTIVE | 2016-12-01 | 2026-12-31 | No data | 5771 ROOSEVELT BLVD., SUITE 610, CLEARWATER, FL, 33760 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2016-12-02 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 500000166215 |
| AMENDMENT | 2008-09-29 | No data | No data |
| REINSTATEMENT | 2001-01-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| AMENDMENT | 1988-09-21 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
