| Entity Name: | BAYSIDE SPEECH THERAPY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 Jan 2015 (10 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 01 Dec 2019 (5 years ago) |
| Document Number: | P15000007631 |
| Address: | 5647 Gulf Drive, New Port Richey, FL, 34652, US |
| Mail Address: | 5647 Gulf Drive, New Port Richey, FL, 34652, US |
| ZIP code: | 34652 |
| County: | Pasco |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1578954962 | 2015-02-07 | 2024-08-02 | 5647 GULF DR, NEW PORT RICHEY, FL, 346524019, US | 5647 GULF DR, NEW PORT RICHEY, FL, 346524019, US | |||||||||||||||||||||||||||
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| Phone | +1 813-435-3355 |
Authorized person
| Name | MRS. NICOLE M YATES |
| Role | SPEECH-LANGUAGE PATHOLOGIST |
| Phone | 8139449594 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014254700 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BAYSIDE SPEECH THERAPY, INC. 401 (K) PLAN | 2023 | 472943694 | 2024-07-05 | BAYSIDE SPEECH THERAPY, INC. | 20 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-05 |
| Name of individual signing | RYAN YATES |
| Valid signature | Filed with authorized/valid electronic signature |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621340 |
| Sponsor’s telephone number | 8139449594 |
| Plan sponsor’s address | 5647 GULF DR, NEW PORT RICHEY, FL, 346524019 |
Signature of
| Role | Plan administrator |
| Date | 2023-08-31 |
| Name of individual signing | RYAN YATES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621340 |
| Sponsor’s telephone number | 8139449594 |
| Plan sponsor’s address | 5647 GULF DR, NEW PORT RICHEY, FL, 346524019 |
Signature of
| Role | Plan administrator |
| Date | 2024-07-05 |
| Name of individual signing | RYAN YATES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Yates Nicole | Agent | 13553 FL-54, Odessa, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| Yates Nicole | President | 13553 FL-54, Odessa, FL, 33556 |
| Name | Role | Address |
|---|---|---|
| Yates Ryan | Secretary | 13553 FL-54, Odessa, FL, 33556 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000069219 | BAYSIDE THERAPY SPECIALISTS | ACTIVE | 2024-06-03 | 2029-12-31 | No data | 5647 GULF DRIVE, NEW PORT RICHEY, FL, 34652 |
| G16000072585 | BAYSIDE PEDIATRIC THERAPY | ACTIVE | 2016-07-21 | 2026-12-31 | No data | 5647 GULF DRIVE, NEW PORT RICHEY, FL, 34652 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-07-11 | 5647 Gulf Drive, New Port Richey, FL 34652 | No data |
| CHANGE OF MAILING ADDRESS | 2024-07-11 | 5647 Gulf Drive, New Port Richey, FL 34652 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-03 | 13553 FL-54, 306, Odessa, FL 33556 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-02-07 | Yates, Nicole | No data |
| AMENDMENT | 2019-12-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-02-07 |
| ANNUAL REPORT | 2021-01-27 |
| ANNUAL REPORT | 2020-01-19 |
| Amendment | 2019-12-01 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-01-18 |
| ANNUAL REPORT | 2017-02-10 |
| ANNUAL REPORT | 2016-01-29 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
