| Entity Name: | DAYTONA AREA SENIOR SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 16 Aug 1995 (29 years ago) |
| Document Number: | N95000003939 |
| FEI/EIN Number | 593331399 |
| Address: | 3800 Woodbriar Trail, Port Orange, FL, 32129, US |
| Mail Address: | 3800 Woodbriar Trail, Port Orange, FL, 32129, US |
| ZIP code: | 32129 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194775395 | 2006-05-11 | 2015-09-16 | 425 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 321142730, US | 425 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL, 32114, US | |||||||||||||||||||||||
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| Phone | +1 386-425-3871 |
| Fax | 3864253873 |
| Phone | +1 386-236-0871 |
| Fax | 3862360873 |
Authorized person
| Name | CYNTHIA TEMPLETON |
| Role | EXECUTIVE DIRECTOR |
| Phone | 3864253871 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 299992379 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KWIATEK KELLY | Agent | 303 NORTH CLYDE MORRIS BLVD., DAYTONA BEACH, FL, 32114 |
| Name | Role | Address |
|---|---|---|
| Kraljic Eveline | Director | 420 Fentress Boulevard, Daytona Beach, FL, 32114 |
| Petkus Matthew | Director | 2669 Old Smyrna Trail, New Smyrna Beach, FL, 32168 |
| Wright Heidi | Director | 425 Sand Creek Ln, Ormond Beach, FL, 32174 |
| Remington Shawn | Director | 84 Black Hickory Way, Ormond Beach, FL, 32174 |
| TINEO ALBERTO | Director | 50 Coquina Ridge Way, Ormond Beach, FL, 32174 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000072053 | HALIFAX HEALTH - CARE AT HOME | ACTIVE | 2012-07-19 | 2027-12-31 | No data | 3800 WOODBRIAR TRAIL, PORT ORANGE, FL, 32129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2012-06-18 | No data | No data |
| AMENDMENT | 2005-12-13 | No data | No data |
| NAME CHANGE AMENDMENT | 2005-08-30 | DAYTONA AREA SENIOR SERVICES, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
