| Entity Name: | HOLMES COUNCIL ON AGING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 08 Dec 1970 (54 years ago) |
| Document Number: | 719812 |
| FEI/EIN Number | 591311210 |
| Address: | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Mail Address: | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| ZIP code: | 32425 |
| County: | Holmes |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588852438 | 2007-10-04 | 2021-05-21 | 210 W KANSAS AVE, BONIFAY, FL, 324251915, US | 210 W KANSAS AVE, BONIFAY, FL, 324251915, US | |||||||||||||||||||||||
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| Phone | +1 850-547-2345 |
| Fax | 8505475271 |
Authorized person
| Name | MICHAEL BROWN |
| Role | EXECUTIVE DIRECTOR |
| Phone | 8505472345 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 670697500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BROWN MICHAEL | Agent | 210 WEST KANSAS AVE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| Josh Jackson | Boar | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Erickson Clint | Boar | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Smith Doug | Boar | 210 West Kansas Ave, Bonifay, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| Brown Michael | Exec | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| Lauren Morris | Secretary | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Name | Role | Address |
|---|---|---|
| Meldon Donna | BOAR | 210 W KANSAS AVE, BONIFAY, FL, 32425 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2019-04-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| AMENDMENT | 2013-09-19 | No data | No data |
| REINSTATEMENT | 2012-09-19 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| NAME CHANGE AMENDMENT | 1979-07-19 | HOLMES COUNCIL ON AGING, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
