| Entity Name: | PROVIDENTIAL HEALTH & REHAB, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Aug 2003 (21 years ago) |
| Date of dissolution: | 26 Sep 2008 (16 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2008 (16 years ago) |
| Document Number: | P03000087782 |
| FEI/EIN Number | 050583363 |
| Address: | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL, 32809, US |
| Mail Address: | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL, 32809, US |
| ZIP code: | 32809 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396950341 | 2007-05-13 | 2020-08-22 | 5205 S ORANGE AVE STE 102, ORLANDO, FL, 328093067, US | 5205 S ORANGE AVE STE 102, ORLANDO, FL, 328093067, US | |||||||||||||||||
|
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| Phone | +1 407-856-8584 |
Authorized person
| Name | MAXIMIN VICTOR |
| Role | MANAGER |
| Phone | 4078568584 |
Taxonomy
| Taxonomy Code | 273Y00000X - Rehabilitation Hospital Unit |
| License Number | HCC6145 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| VICTOR MAXIMIN P | Agent | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| VICTOR MAXIMIN | Director | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL, 32809 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-12 | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL 32809 | No data |
| CHANGE OF MAILING ADDRESS | 2007-05-12 | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL 32809 | No data |
| REGISTERED AGENT NAME CHANGED | 2007-05-12 | VICTOR, MAXIMIN P | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-05-12 | 5205 SOUTH ORANGE AVE #102, ORLANDO, FL 32809 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2007-05-12 |
| ANNUAL REPORT | 2006-05-23 |
| ANNUAL REPORT | 2005-05-02 |
| ANNUAL REPORT | 2004-03-23 |
| Domestic Profit | 2003-08-11 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
