| Entity Name: | PREMIER REHAB, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 09 Dec 1993 (31 years ago) |
| Document Number: | P93000084125 |
| FEI/EIN Number | 59-3214567 |
| Address: | 911 N. SPRING GARDEN AVE, DELAND, FL 32720 |
| Mail Address: | 911 N. SPRING GARDEN AVE, DELAND, FL 32720 |
| ZIP code: | 32720 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467490136 | 2006-06-03 | 2022-09-15 | 911 N SPRING GARDEN AVE, DELAND, FL, 327202560, US | 911 N SPRING GARDEN AVE, DELAND, FL, 32720, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-736-3108 |
| Fax | 3867363643 |
Authorized person
| Name | BARBARA ANNETTE DIVINCENZO |
| Role | ADMINISTRATOR/ CEO |
| Phone | 3867363108 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | 2674 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Taxonomy Code | 261QP2000X - Physical Therapy Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 261QR0400X - Rehabilitation Clinic/Center |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 882094500 |
| State | FL |
| Issuer | MEDICAID |
| Number | 681664996 |
| State | FL |
| Issuer | BLUE CROSS & BLUE SHIELD |
| Number | R5L |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PREMIER REHAB INC 401K | 2023 | 593214567 | 2024-09-02 | PREMIER REHAB INC | 1 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-09-02 |
| Name of individual signing | NICK RICE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DIVINCENZO, BARBARA A | Agent | 1023 MARJORIE RAWLINGS DRIVE, DELAND, FL 32720 |
| Name | Role | Address |
|---|---|---|
| DIVINCENZO, BARBARA A | Director | 911 N. SPRING GARDEN AVE, DELAND, FL 32720 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000063199 | FYZICAL OF DAYTONA | ACTIVE | 2018-05-29 | 2028-12-31 | No data | 911 N SPRING GARDEN AVE, DELAND, FL, 32720 |
| G18000040809 | FYZICAL OF DELAND | ACTIVE | 2018-03-28 | 2028-12-31 | No data | 911 N SPRING GARDEN AVE, DELAND, FL, 32720 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2003-04-09 | 911 N. SPRING GARDEN AVE, DELAND, FL 32720 | No data |
| CHANGE OF MAILING ADDRESS | 2003-04-09 | 911 N. SPRING GARDEN AVE, DELAND, FL 32720 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-04-09 | 1023 MARJORIE RAWLINGS DRIVE, DELAND, FL 32720 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-01-29 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-02-26 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
