| Entity Name: | RURAL HEALTH NETWORK OF MONROE COUNTY, FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 12 Nov 1993 (31 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 30 Nov 2016 (8 years ago) |
| Document Number: | N93000005223 |
| FEI/EIN Number | 65-0474953 |
| Address: | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 |
| Mail Address: | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1225384340 | 2012-07-26 | 2016-04-19 | 3706 N ROOSEVELT BLVD STE D, KEY WEST, FL, 330404566, US | 3706 N ROOSEVELT BLVD, SUITE D, KEY WEST, FL, 330404566, US | |||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 305-517-6613 |
| Fax | 3055176617 |
Authorized person
| Name | DR. DANIEL EUGENE SMITH |
| Role | PRESIDENT & CEO |
| Phone | 3055176613 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | ME49975 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 261QF0400X - Federally Qualified Health Center (FQHC) |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006558500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 006558501 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Halstead, Amy | Agent | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 |
| Name | Role | Address |
|---|---|---|
| Rickert, Scott Dr. | Chairman | 3706 N. Roosevelt Blvd, SUITE C Key West, FL 33040 |
| Name | Role | Address |
|---|---|---|
| Broadie, James | Chief Financial Officer | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Name | Role | Address |
|---|---|---|
| Taweh, Beysolow, Dr. | Chief Marketing Officer | 3706 North Roosevelt Blvd, Suite D Key West, FL 33040-4566 |
| Name | Role | Address |
|---|---|---|
| Teitebaum, Alan | Vice Chairman | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Name | Role | Address |
|---|---|---|
| Ashmore, Victoria | Board Director | 3706 N. ROOSEVELT BLVD, SUITE C KEY WEST, FL 33040 |
| Schultz, Carl | Board Director | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Davis, Pat | Board Director | 3706 N. ROOSEVELT BLVD, SUITE C KEY WEST, FL 33040 |
| Dick, John | Board Director | 3706 N. ROOSEVELT BLVD, SUITE C KEY WEST, FL 33040 |
| WRIGHT, ARIDA | Board Director | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Gates, Gerri | Board Director | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Name | Role | Address |
|---|---|---|
| Halstead, Amy | Chief Executive Officer | 3706 North Roosevelt Blvd, Suite C Key West, FL 33040-4566 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-24 | Halstead, Amy | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-20 | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-20 | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-20 | 3706 North Roosevelt Blvd, Suite C, Key West, FL 33040-4566 | No data |
| AMENDMENT | 2016-11-30 | No data | No data |
| AMENDMENT | 2016-07-11 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000065279 | LAPSED | 1000000242759 | MONROE | 2012-01-05 | 2022-02-01 | $ 1,007.76 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, MIAMI - KEY WEST SERVICE CENTER, 8175 NW 12TH ST STE 418, DORAL FL331261828 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-06 |
| ANNUAL REPORT | 2018-02-20 |
| ANNUAL REPORT | 2017-01-20 |
| Amendment | 2016-11-30 |
| Amendment | 2016-07-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
