| Entity Name: | FORTIES STAFFING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 26 Mar 2015 (10 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P15000028386 |
| FEI/EIN Number | 47-3557381 |
| Address: | 18725 SW 100 AVE, CUTLER BAY, FL, 33157, US |
| Mail Address: | 18725 SW 100 AVE, CUTLER BAY, FL, 33157, US |
| ZIP code: | 33157 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821469362 | 2015-10-09 | 2018-05-28 | 15390 SW 144TH AVE, MIAMI, FL, 331771061, US | 15390 SW 144TH AVE, MIAMI, FL, 33177, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 786-357-0013 |
| Fax | 3058594253 |
Authorized person
| Name | MRS. MAJELA HERNANDEZ |
| Role | ADMINISTRATOR |
| Phone | 7863570013 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 234112 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 372600000X - Adult Companion |
| License Number | 234112 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 376J00000X - Homemaker |
| License Number | 234112 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1821469362 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CANIZARES LUISA L | Agent | 18725 SW 100 AVE, CUTLER BAY, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| CANIZARES LUISA L | President | 18725 SW 100 AVE, CUTLER BAY, FL, 33157 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000056220 | FORTIES HOME CARE | EXPIRED | 2018-05-07 | 2023-12-31 | No data | 15390 SW 144TH AVE, MIAMI, FL, 33177 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-05-14 | 18725 SW 100 AVE, CUTLER BAY, FL 33157 | No data |
| AMENDMENT | 2019-05-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-05-14 | 18725 SW 100 AVE, CUTLER BAY, FL 33157 | No data |
| REGISTERED AGENT NAME CHANGED | 2019-03-14 | CANIZARES, LUISA L | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-09-09 | 18725 SW 100 AVE, CUTLER BAY, FL 33157 | No data |
| AMENDMENT | 2016-05-09 | No data | No data |
| AMENDMENT | 2015-07-17 | No data | No data |
| Name | Date |
|---|---|
| Amendment | 2019-05-14 |
| ANNUAL REPORT | 2019-03-14 |
| ANNUAL REPORT | 2018-09-09 |
| DEBIT MEMO# 028269-B | 2018-06-08 |
| Reg. Agent Change | 2017-08-18 |
| ANNUAL REPORT | 2017-04-13 |
| Amendment | 2016-05-09 |
| ANNUAL REPORT | 2016-04-15 |
| Amendment | 2015-07-17 |
| Domestic Profit | 2015-03-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
