| Entity Name: | QUALI-CARE HOME HEALTH AGENCY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Feb 1996 (29 years ago) |
| Document Number: | P96000010745 |
| FEI/EIN Number | 650642653 |
| Address: | 7750 SW 117 AVENUE, SUITE 307, MIAMI, FL, 33183, US |
| Mail Address: | 7750 SW 117 AVENUE, SUITE 307, MIAMI, FL, 33183, US |
| ZIP code: | 33183 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1447344569 | 2006-10-03 | 2019-04-01 | 18001 OLD CUTLER ROAD, SUITE 454, PALMETTO BAY, FL, 33157, US | 9245 SW 158TH LN FL 2, PALMETTO BAY, FL, 331571804, US | |||||||||||||||||||||||||||
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| Phone | +1 305-232-3979 |
| Fax | 3052325017 |
| Fax | 7865581881 |
Authorized person
| Name | YISSELL SANG |
| Role | ADMINISTRATOR |
| Phone | 3052323979 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | 299990971 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 650766200 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| QUALICARE HOME HEALTH AGENCY 401(K) PLAN | 2023 | 650642653 | 2024-07-22 | QUALI-CARE HOME HEALTH AGENCY INC. | 26 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-07-22 |
| Name of individual signing | CHRIS HORNE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| PEREZ MONICA | Agent | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| PEREZ MONICA | President | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| PEREZ MONICA | Secretary | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| PEREZ MONICA | Director | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| DE LA MAZA CRISTINA | Vice President | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Name | Role | Address |
|---|---|---|
| REIG MARIA | Treasurer | 9245 SW 158 Lane, MIAMI, FL, 33157 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2015-11-17 | No data | No data |
| AMENDMENT | 2015-05-20 | No data | No data |
| AMENDMENT | 2012-10-09 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
