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  5. RIVERSIDE CARE CENTER, INC

RIVERSIDE CARE CENTER, INC

Company Details

Entity Name: RIVERSIDE CARE CENTER, INC
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 21 Dec 2021 (3 years ago)
Document Number: P22000000145
FEI/EIN Number 87-4217153
Address: 402 NORTH RIVERSIDE DRIVE, NEW SMYRNA BEACH, FL 32168
Mail Address: 12802 GROVEHURST AVE, WINTER GARDEN, FL 34787 UN
ZIP code: 32168
County: Volusia
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1619741063 2023-11-07 2023-11-07 402 N RIVERSIDE DR, NEW SMYRNA BEACH, FL, 321686740, US 402 N RIVERSIDE DR, NEW SMYRNA BEACH, FL, 321686740, US

Contacts
Phone +1 386-423-1120
Fax 3869573770

Authorized person
Name SANDRA VENORD DORVAL
Role OWNER/ADMINISTRATOR
Phone 3219476368

Taxonomy
Taxonomy Code 310400000X - Assisted Living Facility
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RIVERSIDE CARE CENTER 2017 311011518 2018-11-21 RIVERSIDE CARE CENTER 107
File View Page
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 108
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2018-11-21
Name of individual signing RICHARD STACEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE CARE CENTER 2016 311011518 2017-11-17 RIVERSIDE CARE CENTER 105
File View Page
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 107
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0

Signature of
Role Plan administrator
Date 2017-11-17
Name of individual signing SHEILA BERNING
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE CARE CENTER 2015 311011518 2016-10-03 RIVERSIDE CARE CENTER 73
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Plan administrator’s name and address
Administrator’s EIN 651056686
Plan administrator’s name PEOPLE FIRST, INC.
Plan administrator’s address 1860 N. PINE ISLAND ROAD #106, PLANTATION, FL, 33322
Administrator’s telephone number 9545876100

Number of participants as of the end of the plan year
Active participants 105
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-03
Name of individual signing BARBARA FLYNN
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE CARE CENTER 2015 311011518 2016-10-13 RIVERSIDE CARE CENTER 73
File View Page
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 105
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2016-10-12
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE CARE CENTER 2014 311011518 2015-08-27 RIVERSIDE CARE CENTER 91
File View Page
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 73
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2015-08-27
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature
RIVERSIDE CARE CENTER 2013 311011518 2014-10-03 RIVERSIDE CARE CENTER 90
File View Page
Three-digit plan number (PN) 512
Effective date of plan 2013-05-01
Business code 623000
Sponsor’s telephone number 3053261236
Plan sponsor’s mailing address 899 NW 4TH STREET, MIAMI, FL, 33128
Plan sponsor’s address 899 NW 4TH STREET, MIAMI, FL, 33128

Number of participants as of the end of the plan year
Active participants 113
Retired or separated participants receiving benefits 0
Other retired or separated participants entitled to future benefits 0
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits 0
Number of participants with account balances as of the end of the plan year 0
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 0

Signature of
Role Plan administrator
Date 2014-10-03
Name of individual signing RALPH STACEY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DORVAL, CALEB Agent 12802 GROVEHURST AVE, WINTER GARDEN, FL 34787

President

Name Role Address
DORVAL, SANDRA V President 12802 GROVEHURST AVE, WINTER GARDEN, FL 34787

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G22000001136 TIFFANY ON THE RIVER ACTIVE 2022-01-04 2027-12-31 No data 12802 GROVEHURST AVE, WINTER GARDEN, FL, 34787

Debts

Document Number Status Case Number Name of Court Date of Entry Expiration Date Amount Due Plaintiff
J24000758282 ACTIVE 1000001020647 VOLUSIA 2024-11-21 2034-11-27 $ 823.96 STATE OF FLORIDA, DEPARTMENT OF REVENUE, DAYTONA BEACH SERVICE CENTER, 1180 N WILLIAMSON BLVD STE 160, DAYTONA BEACH FL321148179

Documents

Name Date
ANNUAL REPORT 2024-04-28
ANNUAL REPORT 2023-04-16
Domestic Profit 2021-12-21

Related by officers

DORVAL, CALEB

DORCAS INVESTMENT, LLC PRESTIGE CARE ASSISTED LIVING, LLC D&M FAMILY GROUP INC TRASH CAN EAGLE, LLC ACE CLEANING SOLUTIONS, INC.

DORVAL, SANDRA V

PRESTIGE CARE ASSISTED LIVING, LLC QUALITY CARE STAFFING, INC

Related by address

No related companies by address

Date of last update: 13 Jan 2025

Sources: Florida Department of State

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