| Entity Name: | COMMUNITY VICTORY FAMILY SERVICES INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Feb 2018 (7 years ago) |
| Document Number: | P18000013425 |
| FEI/EIN Number | 36-4892026 |
| Address: | 15438 N. Florida Ave, Tampa, FL, 33613, US |
| Mail Address: | 15438 N. Florida Ave, Tampa, FL, 33613, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346735008 | 2018-06-26 | 2018-06-26 | PO BOX 7731, WESLEY CHAPEL, FL, 335450113, US | 8905 REGENTS PARK DR STE 230, TAMPA, FL, 336473081, US | |||||||||||||||||||||||||
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| Phone | +1 800-715-3606 |
| Fax | 8139060206 |
Authorized person
| Name | MR. TAIWAN SIMMONS |
| Role | DIRECTOR OF OPERATIONS |
| Phone | 8007153606 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH13166 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 014618400 |
| State | FL |
| Name | Role |
|---|---|
| INSIDE REACH MINISTRIES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| SIMMONS SHNAI | President | 15438 N. Florida Ave, Tampa, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| SIMMONS TAIWAN | Vice President | 15438 N. Florida Ave, Tampa, FL, 33613 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000006293 | THE COLLECTIVE WELLNESS INSTITUTE | ACTIVE | 2021-01-12 | 2026-12-31 | No data | P. O. BOX 7731, WESLEY CHAPEL, FL, 33545 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2023-04-30 | 15438 N. Florida Ave, 106, Tampa, FL 33613 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-12 | 15438 N. Florida Ave, 106, Tampa, FL 33613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-01-12 | 15438 N. Florida Ave, 106, Tampa, FL 33613 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-29 |
| ANNUAL REPORT | 2023-04-30 |
| ANNUAL REPORT | 2022-01-06 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-09 |
| ANNUAL REPORT | 2019-05-15 |
| Domestic Profit | 2018-02-08 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
