| Entity Name: | AVANTE CARE OF HOLLYWOOD, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Sep 2012 (12 years ago) |
| Document Number: | P12000082467 |
| FEI/EIN Number | 46-1083711 |
| Mail Address: | 5900 LAKE ELLENOR DR, SUITE 700A, ORLANDO, FL, 32809, US |
| Address: | 1200 ARTHUR STREET, HOLLYWOOD, FL, 33019, US |
| ZIP code: | 33019 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629310420 | 2013-03-20 | 2022-03-17 | 5900 LAKE ELLENOR DR STE 700, ORLANDO, FL, 328094643, US | 1200 ARTHUR ST, HOLLYWOOD, FL, 330193118, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 407-216-0101 |
| Fax | 4073182477 |
| Phone | +1 954-926-5600 |
| Fax | 9549268080 |
Authorized person
| Name | KIMBERLY L. BIEGASIEWICZ |
| Role | PRESIDENT |
| Phone | 4072160101 |
Taxonomy
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| License Number | AL9201 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009938300 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| HORNACK JOHN C | Secretary | 5900 LAKE ELLENOR DR, ORLANDO, FL, 32809 |
| Name | Role | Address |
|---|---|---|
| BIEGASIEWICZ KIMBERLY L | Director | 5900 LAKE ELLENOR DR, ORLANDO, FL, 32809 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000114131 | MAJESTIC MEMORY CARE CENTER | EXPIRED | 2013-11-20 | 2018-12-31 | No data | 1200 ARTHUR STREET, HOLLYWOOD, FL, 33019 |
| G12000126410 | BAY POINTE TERRACE | EXPIRED | 2012-12-28 | 2017-12-31 | No data | 1200 ARTHUR STREET, HOLLYWOOD, FL, 33019 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-06-06 | 1200 ARTHUR STREET, HOLLYWOOD, FL 33019 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-11-11 | Corporation Service Company | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-10-14 | 1201 Hays Street, Tallahassee, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-15 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-23 |
| ANNUAL REPORT | 2021-03-14 |
| ANNUAL REPORT | 2020-06-06 |
| AMENDED ANNUAL REPORT | 2019-06-16 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-04-26 |
| AMENDED ANNUAL REPORT | 2016-09-30 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
