| Entity Name: | PUTNAM COUNTY ALCOHOL AND DRUG COUNCIL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 30 Jun 1971 (54 years ago) |
| Document Number: | 721379 |
| FEI/EIN Number | 591392526 |
| Address: | 330 KAY LARKIN DR, PALATKA, FL, 32177 |
| Mail Address: | 330 KAY LARKIN DR, PALATKA, FL, 32177 |
| ZIP code: | 32177 |
| County: | Putnam |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1023013729 | 2005-06-17 | 2011-12-29 | 330 KAY LARKIN DR, PALATKA, FL, 321772307, US | 330 KAY LARKIN DR, PALATKA, FL, 321772307, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 386-329-3780 |
| Fax | 3863851269 |
Authorized person
| Name | MRS. JOYCE C MILLER |
| Role | CHAIRPERSON BOARD OF DIRECTORS |
| Phone | 3863254714 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 324500000X - Substance Abuse Rehabilitation Facility |
| License Number | 0354AD252601 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BC/BS |
| Number | 38327 |
| State | FL |
| Issuer | MEDICAID |
| Number | 360349100 |
| State | FL |
| Issuer | VALUE OPTIONS |
| Number | 335268 |
| State | FL |
| Issuer | MAGELLAN |
| Number | 60023030 |
| State | FL |
| Issuer | MEDICAID CARE MGMT |
| Number | 758545400 |
| State | FL |
| Issuer | WELLCARE |
| Number | 274738 |
| State | FL |
| Issuer | MEDICAID COMP. ACCESS |
| Number | 760471800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MILLER JOYCE | Agent | 1039 US HWY 17, BOSTWICK, FL, 32007 |
| Name | Role | Address |
|---|---|---|
| BATES BEN | Director | 3400 CRILL AVENUE, PALATKA, FL, 32177 |
| TAYLOR SAMUEL | Director | P.O. BOX 162, EAST PALATKA, FL, 32131 |
| DOUGLAS TAYLOR | Director | 105 SHADY OAK LANE, PALATKA, FL, 32178 |
| DRIGGERS STEVE | Director | PO BOX 68, EAST PALATKA, FL, 32131 |
| SMITH TITO | Director | PO BOX 798, PALATKA, FL, 32177 |
| BROWN LAWSON | Director | 107 S. 9TH ST., PALATKA, FL, 32177 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOL DISSOLUTION OF INACTIVE CORP | 2012-12-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| AMENDMENT | 1988-12-23 | No data | No data |
| AMENDMENT | 1985-11-06 | No data | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
