| Entity Name: | MOUNTAINEER'S THERAPEUTIC CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Jun 2017 (8 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 28 Nov 2018 (6 years ago) |
| Document Number: | P17000053923 |
| FEI/EIN Number | 82-1968092 |
| Address: | 1340 KENWOOD ROAD, WEST PALM BEACH, FL, 33401, US |
| Mail Address: | 1340 KENWOOD ROAD, WEST PALM BEACH, FL, 33401, US |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558936583 | 2021-05-21 | 2021-05-21 | 1340 KENWOOD RD, WEST PALM BEACH, FL, 334017408, US | 1340 KENWOOD RD, WEST PALM BEACH, FL, 334017408, US | |||||||||||||||||||||||
|
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| Phone | +1 561-932-3938 |
Authorized person
| Name | NICOLE HUNNINGS |
| Role | DIRECTOR |
| Phone | 9103665772 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024725200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALSH MARY JOSEPHINE | Agent | 1340 Kenwood Road, West Palm Beach, FL, 33401 |
| Name | Role | Address |
|---|---|---|
| WALSH MARY JOSEPHINE | President | 1340 Kenwood Road, West Palm Beach, FL, 33401 |
| Name | Role | Address |
|---|---|---|
| WALSH-WATSON LEONARD | Vice President | 1340 Kenwood Road, West Palm Beach, FL, 33401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-01-31 | WALSH, MARY JOSEPHINE | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-01-21 | 1340 Kenwood Road, West Palm Beach, FL 33401 | No data |
| AMENDMENT | 2018-11-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-11-28 | 1340 KENWOOD ROAD, WEST PALM BEACH, FL 33401 | No data |
| AMENDMENT | 2017-11-08 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-11-08 | 1340 KENWOOD ROAD, WEST PALM BEACH, FL 33401 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-02-20 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-03-08 |
| Amendment | 2018-11-28 |
| ANNUAL REPORT | 2018-01-12 |
| Amendment | 2017-11-08 |
| Domestic Profit | 2017-06-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
