| Entity Name: | AVA REHABILITATION CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Mar 2002 (23 years ago) |
| Document Number: | P02000032862 |
| FEI/EIN Number | 010655767 |
| Address: | 1342 STATE ROAD 60E, LAKE WALES, FL, 33853 |
| Mail Address: | 2170 Crosston Circle, Orlando, FL, 32824, US |
| ZIP code: | 33853 |
| County: | Polk |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447206917 | 2006-05-26 | 2021-01-13 | 1342 STATE ROAD 60 E, LAKE WALES, FL, 338534322, US | 1342 STATE ROAD 60 E, LAKE WALES, FL, 338534322, US | |||||||||||||||||||||||
|
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| Phone | +1 863-676-8300 |
| Fax | 8636761300 |
Authorized person
| Name | DR. POLA GAYED |
| Role | OWNER |
| Phone | 8636768300 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | PT3913 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DD6113 |
| Name | Role | Address |
|---|---|---|
| Pola Gayed Dr. | Agent | 2170 Crosston Circle, Orlando, FL, 32824 |
| Name | Role | Address |
|---|---|---|
| Gayed Pola Dr. | President | 2170 Crosston Circle, Orlando, FL, 32824 |
| Name | Role | Address |
|---|---|---|
| Ayad Ledia | Officer | 2170 Crosston Circle, Orlando, FL, 32824 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2021-01-04 | 1342 STATE ROAD 60E, LAKE WALES, FL 33853 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-01-04 | Pola, Gayed, Dr. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-04 | 2170 Crosston Circle, Orlando, FL 32824 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-01-04 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-01-19 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-01-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
