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Applicants must include the following attachments as stated in Chapters 408, Part II, and 429 Part III, Florida Statutes (F.S.), , and Chapters 59A-35 and 58A-6, Florida Administrative Code (F.A.C.). Applications mus
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Document Date: 2014-09-19 09:50:17


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City

Tallahassee / Mail Stop / A Dublin / /

Company

The Agency for Health Care Administration / Agency for Persons / State Limited Liability Company / Agency for Health Care Administration Case / Cogent Systems / Profit Public Corporation Corporation / /

Currency

USD / /

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Event

Company Expansion / Business Partnership / /

IndustryTerm

liability insurance coverage / bank statements / ownership applications / requested information / law enforcement personnel / basic and optional services / /

MedicalTreatment

Self-Care / /

Organization

Department of State / Department of Financial Services / Dept of Health / Florida Department of Law Enforcement / State Division of Corporations / officers of Management Company If / Licensee AUTHORITY / officers of Licensee TITLE FULL NAME PERSONAL OR BUSINESS ADDRESS TELEPHONE NUMBER / officers of Management Company TITLE FULL NAME PERSONAL OR BUSINESS ADDRESS TELEPHONE NUMBER / Municipal Government / Adult Day Care Center / Department of Children and Families / Department of Health / Division of Corporations / Long Term Care Unit / Medicare / /

Person

Adult Day / /

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Position

Chief Financial Officer / board member / TITLE NAME TELEHPONE NUMBER E-MAIL Center Operator Chief Financial Officer / administrator / Administrator and Chief Financial Officer / OWNERSHIP INTEREST Director/CEO President Vice President Secretary Treasurer / authorized representative / Representative / officer / Florida Secretary / /

Product

Form 3110-1024 / Form / /

ProgrammingLanguage

FL / /

ProvinceOrState

Ohio / Florida / /

Technology

http / /

URL

http /

SocialTag