| Entity Name: | PACHOT GROUP HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Jun 2004 (21 years ago) |
| Document Number: | P04000097166 |
| FEI/EIN Number | 201908558 |
| Address: | 3905 TIMBER TRAIL, ORLANDO, FL, 32808 |
| Mail Address: | 13431 Zori Lane, Windermere, FL, 34786, US |
| ZIP code: | 32808 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043510928 | 2010-10-26 | 2010-10-26 | 13431 ZORI LN, WINDERMERE, FL, 347867315, US | 3905 TIMBER TRL, ORLANDO, FL, 328082344, US | |||||||||||||||||||||||||
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| Phone | +1 407-292-9031 |
| Fax | 4076568484 |
Authorized person
| Name | MRS. JACQUELINE ROSA |
| Role | MANAGER |
| Phone | 4072929031 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| License Number | 7G319 A/C |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 688378896 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ROSA JACQUELINE L | Agent | 3905 TIMBER TRAIL, ORLANDO, FL, 32808 |
| Name | Role | Address |
|---|---|---|
| ROSA JACQUELINE L | President | 3905 TIMBER TRAIL, ORLANDO, FL, 32808 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-08 | 3905 TIMBER TRAIL, ORLANDO, FL 32808 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-25 |
| ANNUAL REPORT | 2023-03-23 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-03-07 |
| ANNUAL REPORT | 2020-04-24 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-04-06 |
| ANNUAL REPORT | 2017-02-21 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-03-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
