| Entity Name: | URBAN JACKSONVILLE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 26 Feb 1968 (57 years ago) |
| Document Number: | 714162 |
| FEI/EIN Number | 237024899 |
| Address: | 4250 LAKESIDE DR, SUITE 116, JACKSONVILLE, FL, 32210, US |
| Mail Address: | 4250 LAKESIDE DR, SUITE 116, JACKSONVILLE, FL, 32210, US |
| ZIP code: | 32210 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902066160 | 2008-06-11 | 2023-03-27 | 4250 LAKESIDE DR STE 116, JACKSONVILLE, FL, 322103300, US | 4250 LAKESIDE DR STE 116, JACKSONVILLE, FL, 322103300, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 904-807-1203 |
| Fax | 9048071220 |
Authorized person
| Name | TERESA BARTON |
| Role | CEO |
| Phone | 9048071240 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 105912900 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| BERG REBECCA | Inne | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| HARMON ANDREW | Chairman | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| RUTLAND ALFRED W | Director | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| WILBURN SHARON | Director | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| WEATHERBY MICHAEL | Director | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| Name | Role | Address |
|---|---|---|
| BARTON TERESA K | Chief Executive Officer | 4250 LAKESIDE DR, JACKSONVILLE, FL, 32210 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000017958 | CLAY COUNTY SENIOR SERVICES OF AGING TRUE | ACTIVE | 2021-02-05 | 2026-12-31 | No data | 604 WALNUT STREET, GREEN COVE SPRINGS, FL, 32043 |
| G11000100800 | AGING TRUE HOME HEALTH | ACTIVE | 2011-10-13 | 2026-12-31 | No data | 4250 LAKESIDE DRIVE SUITE 116, JACKSONVILLE, FL, 32210 |
| G11000083283 | AGING TRUE | ACTIVE | 2011-08-22 | 2026-12-31 | No data | 4250 LAKESIDE DRIVE SUITE 300, JACKSONVILLE, FL, 32210 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
