| Entity Name: | OPTIMUM REHAB, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 May 1994 (31 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 25 Feb 1999 (26 years ago) |
| Document Number: | P94000035378 |
| FEI/EIN Number | 593237870 |
| Address: | 1061 S Sun Dr, LAKE MARY, FL, 32746, US |
| Mail Address: | 1061 S Sun Dr, LAKE MARY, FL, 32746, US |
| ZIP code: | 32746 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285788083 | 2007-01-22 | 2021-12-06 | 1061 S SUN DR STE 1089, LAKE MARY, FL, 327466169, US | 1061 S SUN DR STE 1089, LAKE MARY, FL, 327466169, US | |||||||||||||||||||||
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| Phone | +1 407-323-6955 |
| Fax | 8553062974 |
Authorized person
| Name | FABIAN RUIZ |
| Role | PRESIDENT |
| Phone | 4073236955 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 015720500 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OPTIMUM REHAB INC. 401(K) PLAN | 2023 | 593237870 | 2024-05-07 | OPTIMUM REHAB INC. | 7 | |||||||||||||||||||||||||||||||
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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 | 2024-05-07 |
| 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 | 2022-01-01 |
| Business code | 621340 |
| Sponsor’s telephone number | 4079850658 |
| Plan sponsor’s address | 1061 S SUN DR ST., STE 1089, LAKE MARY, FL, 32746 |
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 | 2023-05-30 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Ruiz-Cortes Fabian A | Agent | 1061 S Sun Dr, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| Ruiz-Cortes Fabian A | President | 1061 S Sun Dr, LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2021-12-09 | 1061 S Sun Dr, Ste1089, LAKE MARY, FL 32746 | No data |
| CHANGE OF MAILING ADDRESS | 2021-12-09 | 1061 S Sun Dr, Ste1089, LAKE MARY, FL 32746 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-12-09 | 1061 S Sun Dr, Ste1089, LAKE MARY, FL 32746 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-10-29 | Ruiz-Cortes, Fabian A | No data |
| REINSTATEMENT | 1999-02-25 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1998-10-16 | No data | No data |
| AMENDMENT AND NAME CHANGE | 1994-11-10 | OPTIMUM REHAB, INC. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-26 |
| AMENDED ANNUAL REPORT | 2021-12-09 |
| ANNUAL REPORT | 2021-01-20 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-02-18 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-29 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
