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AVESIS OF FLORIDA, INC. - Florida Company Profile

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Company Details

Entity Name: AVESIS OF FLORIDA, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 02 Nov 2023 (2 years ago)
Document Number: P23000077051
FEI/EIN Number 93-4247938
Address: 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281, US
Mail Address: 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281, US
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
HEENAN GARRETT Director 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281
BAILEY BARY Director 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281
MOLLY WADE Director 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281
ROTHROCK KIRK Director 1295 W WASHINGTON ST STE 212, TEMPLE, AZ, 85281
- Agent -

National Provider Identifier

NPI Number:
1518788967
Certification Date:
2024-10-16

Authorized Person:

Name:
DR. PAUL JASON MANN
Role:
CHIEF CLINICAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
302R00000X - Health Maintenance Organization
Is Primary:
Yes

Contacts:

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2024-11-13 1295 W WASHINGTON ST STE 212, TEMPLE, AZ 85281 -
CHANGE OF MAILING ADDRESS 2024-11-13 1295 W WASHINGTON ST STE 212, TEMPLE, AZ 85281 -

Documents

Name Date
ANNUAL REPORT 2025-01-30
AMENDED ANNUAL REPORT 2024-11-13
ANNUAL REPORT 2024-02-27
Domestic Profit 2023-11-02

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Date of last update: 01 Jul 2025

Sources: Florida Department of State