| Entity Name: | FAMILY EXTENDED CARE OF VERO BEACH, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 18 Feb 1999 (26 years ago) |
| Document Number: | N99000001054 |
| FEI/EIN Number | 650897699 |
| Address: | 2700 WEST 81 STREET, HIALEAH, FL, 33016, US |
| Mail Address: | 2700 WEST 81 STREET, HIALEAH, FL, 33016, US |
| ZIP code: | 33016 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811193329 | 2007-06-22 | 2019-12-03 | 1934 22ND AVE, VERO BEACH, FL, 329603084, US | 1934 22ND AVE, VERO BEACH, FL, 329603084, US | |||||||||||||||||||||||||
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| Phone | +1 772-794-1277 |
Authorized person
| Name | TIFFANY COLLINS |
| Role | DIRECTOR OF OPERATIONS |
| Phone | 4077618473 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 101426000 |
| State | FL |
| Issuer | MEDICAID |
| Number | 103533500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LUSTIG ROY R | Agent | 20900 NE 30th Avenue, Aventura, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| GLUCK LINDA | President | 2700 WEST 81 STREET, HIALEAH, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| RODRIGUEZ BETTY | Chief Financial Officer | 2700 WEST 81 STREET, HIALEAH, FL, 33016 |
| Name | Role | Address |
|---|---|---|
| WALKER LINDA | Chief Operating Officer | 2700 WEST 81 STREET, HIALEAH, FL, 33016 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000111383 | FAMILY EXTENDED CARE OF VERO BEACH | ACTIVE | 2017-10-09 | 2028-12-31 | No data | 2700 W. 81 STREET, HIALEAH, FL, 33016 |
| G17000111387 | GREEN GABLES ASSISTED LIVING FACILITY | EXPIRED | 2017-10-09 | 2022-12-31 | No data | 2700 W. 81 STREET, HIALEAH, FL, 33016 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT AND NAME CHANGE | 2017-10-13 | FAMILY EXTENDED CARE OF VERO BEACH, INC. | No data |
| AMENDMENT | 2001-12-26 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
