| Entity Name: | CREIGHTON HEALTH CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 03 Jun 1997 (28 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Apr 2016 (9 years ago) |
| Document Number: | P97000049512 |
| FEI/EIN Number | 59-3452392 |
| Address: | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Mail Address: | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| ZIP code: | 33612 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558402479 | 2007-02-12 | 2020-08-22 | 9724 N ARMENIA AVE, SUITE 100, TAMPA, FL, 336127550, US | 9724 N ARMENIA AVE, SUITE 100, TAMPA, FL, 336127550, US | |||||||||||||||||||
|
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| Phone | +1 813-915-8666 |
| Fax | 8139309536 |
Authorized person
| Name | TARA DEJESUS |
| Role | MANAGER |
| Phone | 8139158666 |
Taxonomy
| Taxonomy Code | 204D00000X - Neuromusculoskeletal Medicine & OMM Physician |
| License Number | 0038694 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CREIGHTON HEALTH CARE INC | 2022 | 593452392 | 2024-01-17 | CREIGHTON HEALTH CARE INC | 3 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2024-01-17 |
| Name of individual signing | LORIAN RIVERS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 8139158666 |
| Plan sponsor’s address | 9724 N ARMENIA AVE STE 100, TAMPA, FL, 33612 |
Signature of
| Role | Plan administrator |
| Date | 2022-06-06 |
| Name of individual signing | LORIAN RIVERS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| CREIGHTON, CLARA SM.D. | Agent | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Name | Role | Address |
|---|---|---|
| CREIGHTON, CLARA SM.D. | Director | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Name | Role | Address |
|---|---|---|
| CREIGHTON, CLARA SM.D. | President | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Name | Role | Address |
|---|---|---|
| CREIGHTON, CLARA SM.D. | Secretary | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Name | Role | Address |
|---|---|---|
| CREIGHTON, CLARA SM.D. | Treasurer | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2016-04-01 | CREIGHTON, CLARA SM.D. | No data |
| REINSTATEMENT | 2016-04-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-04-08 | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-04-08 | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 | No data |
| CHANGE OF MAILING ADDRESS | 2008-04-08 | 9724 NORTH ARMENIA AVE, SUITE 100, TAMPA, FL 33612 | No data |
| REINSTATEMENT | 2001-02-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2000-09-22 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000243720 | TERMINATED | 1000000212161 | HILLSBOROU | 2011-04-18 | 2031-04-20 | $ 10,359.34 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 6302 E DR MARTIN LUTHER KING JR BLVD S, TAMPA FL336191166 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-09 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-02-08 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-04-15 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-05-01 |
| REINSTATEMENT | 2016-04-01 |
| ANNUAL REPORT | 2014-09-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
