| Entity Name: | HOME AT LAST OF BREVARD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 25 Jun 2002 (23 years ago) |
| Last Event: | CANCEL ADM DISS/REV |
| Event Date Filed: | 19 May 2009 (16 years ago) |
| Document Number: | P02000070248 |
| FEI/EIN Number | 42-1541455 |
| Address: | 2475 Palm Bay Rd. Suite 225, Palm Bay, FL 32905 |
| Mail Address: | 2475 Palm Bay Rd. Suite 225, Palm Bay, FL 32905 |
| ZIP code: | 32905 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508169657 | 2010-12-13 | 2010-12-13 | 2333 JUPITER BLVD SW, PALM BAY, FL, 329083416, US | 2333 JUPITER BLVD SW, PALM BAY, FL, 329083416, US | |||||||||||||||||||||||||||
|
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| Phone | +1 321-508-4639 |
Authorized person
| Name | MR. ALVIN PAYNE |
| Role | PRESIDENT |
| Phone | 3215084639 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID WAIVER |
| Number | 674701996 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PAYNE, ALVIN | Agent | 2598 Jaremko Ave. SE, PALM BAY, FL 32909 |
| Name | Role | Address |
|---|---|---|
| PAYNE, ALVIN | President | 2598 Jaremko Ave. SE., PALM BAY, FL 32909 |
| Name | Role | Address |
|---|---|---|
| Payne, Chanell Lynn | Officer | 2598 Jaremko Ave. SE, Palm Bay, FL 32909 |
| Name | Role | Address |
|---|---|---|
| Johnson, Tiffany | Director of Operations | 759 Hainey St, Palm Bay, FL 32908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-10 | 2475 Palm Bay Rd. Suite 225, Palm Bay, FL 32905 | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-10 | 2475 Palm Bay Rd. Suite 225, Palm Bay, FL 32905 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-02-15 | 2598 Jaremko Ave. SE, PALM BAY, FL 32909 | No data |
| CANCEL ADM DISS/REV | 2009-05-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2006-10-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| CANCEL ADM DISS/REV | 2005-12-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2005-09-16 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000850112 | TERMINATED | 1000000184197 | BREVARD | 2010-08-10 | 2020-08-18 | $ 6,015.20 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, COCOA SERVICE CENTER, 2428 CLEARLAKE RD STE M, COCOA FL329225731 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| AMENDED ANNUAL REPORT | 2023-03-12 |
| ANNUAL REPORT | 2023-02-20 |
| ANNUAL REPORT | 2022-03-24 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-04-10 |
| AMENDED ANNUAL REPORT | 2018-06-06 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-17 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
