| Entity Name: | AVANTI HOME HEALTH OF PALM BEACH CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 07 Feb 2011 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 18 Oct 2022 (2 years ago) |
| Document Number: | P11000013257 |
| FEI/EIN Number | 800683978 |
| Address: | 1015 Gateway Blvd., Suite 502, Boynton Beach, FL, 33426, US |
| Mail Address: | 1015 Gateway Blvd., Suite 502, Boynton Beach, FL, 33426, US |
| ZIP code: | 33426 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104118975 | 2011-05-11 | 2022-12-01 | 1015 GATEWAY BLVD STE 502, BOYNTON BEACH, FL, 334268347, US | 1015 GATEWAY BLVD STE 502, BOYNTON BEACH, FL, 334268347, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 561-733-1390 |
| Fax | 5617399456 |
Authorized person
| Name | MR. MARK CONKLIN |
| Role | OWNER, CEO |
| Phone | 5617331390 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| Is Primary | No |
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 299993913 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 113570300 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATE CREATIONS NETWORK INC. | Agent |
| Name | Role | Address |
|---|---|---|
| CONKLIN MARK | Manager | 1015 GATEWAY BLVD., BOYNTON BEACH, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-04-03 | 1015 Gateway Blvd., Suite 502, Boynton Beach, FL 33426 | No data |
| CHANGE OF MAILING ADDRESS | 2023-04-03 | 1015 Gateway Blvd., Suite 502, Boynton Beach, FL 33426 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-10-18 | 801 US Highway 1, North Palm Beach, FL 33408 | No data |
| REINSTATEMENT | 2022-10-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2022-10-18 | Corporate Creations Network Inc. | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| AMENDMENT | 2022-01-03 | No data | No data |
| AMENDMENT | 2021-12-13 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-25 |
| ANNUAL REPORT | 2023-04-03 |
| REINSTATEMENT | 2022-10-18 |
| Amendment | 2022-01-03 |
| Amendment | 2021-12-13 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-19 |
| ANNUAL REPORT | 2017-04-27 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
