| Entity Name: | ATLANTIC HEALTH MEDICAL, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 15 Jul 2021 (4 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Sep 2023 (a year ago) |
| Document Number: | P21000064796 |
| FEI/EIN Number | 871696197 |
| Address: | 1380 NE MIAMI GARDENS DRIVE, 210, NORTH MIAMI BEACH, FL, 33179, US |
| Mail Address: | 1380 NE MIAMI GARDENS DRIVE, 210, NORTH MIAMI BEACH, FL, 33179, US |
| ZIP code: | 33179 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770156838 | 2021-07-19 | 2021-07-19 | 1380 NE MIAMI GARDENS DR STE 210, NORTH MIAMI BEACH, FL, 331794709, US | 1380 NE MIAMI GARDENS DR STE 210, NORTH MIAMI BEACH, FL, 331794709, US | |||||||||||||||||||||
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| Phone | +1 305-931-7424 |
| Fax | 3059317425 |
Authorized person
| Name | MR. VOLRICK DARRELL MORRISON |
| Role | PRESIDENT/PHYSICIAN |
| Phone | 3059317424 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001336200 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ATLANTIC HEALTH MEDICAL, INC 401(K) PLAN | 2023 | 871696197 | 2024-05-23 | ATLANTIC HEALTH MEDICAL, INC | 8 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-23 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-03-01 |
| Business code | 621112 |
| Sponsor’s telephone number | 3059317424 |
| Plan sponsor’s address | 1380 NE MIAMI GARDENS DR SUITE 210, NORTH MIAMI BEACH, FL, 33179 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-08-11 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| MORRISON VOLRICK D | Agent | 1380 NE MIAMI GARDENS DRIVE, NORTH MIAMI BEACH, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| MORRISON VOLRICK D | President | PO BOX 4372, Boynton Beach, FL, 33424 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2023-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-09-25 | MORRISON, VOLRICK D | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| REINSTATEMENT | 2023-09-25 |
| ANNUAL REPORT | 2022-09-21 |
| Domestic Profit | 2021-07-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
