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LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.

LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.

Company Details

Entity Name:	LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.
Jurisdiction:	FLORIDA
Filing Type:	Florida Not For Profit Corporation
Status:	Active
Date Filed:	21 Sep 1971 (53 years ago)
Last Event:	AMENDMENT
Event Date Filed:	31 Aug 2017 (7 years ago)
Document Number:	721746
FEI/EIN Number	59-1375195
Address:	525 East Fifteenth Street, Panama City, FL 32405
Mail Address:	525 East Fifteenth Street, Panama City, FL 32405
ZIP code:	32405
County:	Bay
Place of Formation:	FLORIDA

National Provider Identifier

NPI

Enumeration Date

Last Update Date

Mailing Address

Practice Location Address

1003022369

2007-05-15

2008-07-31

525 E 15TH ST, PANAMA CITY, FL, 324055412, US

Contacts

Phone	+1 850-522-4480
Fax	8509146281

Authorized person

Name	MR. EDWIN R. AILES
Role	EXECUTIVE DIRECTOR
Phone	8505228840

Taxonomy

Taxonomy Code	251S00000X - Community/Behavioral Health Agency
Is Primary	Yes

Other Provider Identifiers

Issuer	MEDICAID
Number	141301500
State	FL

Agent

Name	Role	Address
AILES, EDWIN R	Agent	525 East Fifteenth Street, Panama City, FL 32405

Chief Financial Officer

Name	Role	Address
Dawn, William	Chief Financial Officer	525 East Fifteenth Street, Panama City, FL 32405

Chief Executive Officer

Name	Role	Address
Ailes, Edwin	Chief Executive Officer	525 East 15th Street, Panama, FL 32405

Treasurer

Name	Role	Address
Thomas, Ken	Treasurer	525 East Fifteenth Street, Panama City, FL 32405

Board member

Name	Role	Address
Merritt, Frank, Dr.	Board member	525 East Fifteenth Street, Panama City, FL 32405

Vice Chairman

Name	Role	Address
Crayton, Dinah	Vice Chairman	525 East Fifteenth Street, Panama City, FL 32405

Secretary

Name	Role	Address
Shoaf, Ashley	Secretary	525 East Fifteenth Street, Panama City, FL 32405

Board Chair

Name	Role	Address
D'Isernia, Jr, Brian	Board Chair	525 East Fifteenth Street, Panama City, FL 32405

Boardmember

Name	Role	Address
Bennett, Tony	Boardmember	525 East Fifteenth Street, Panama City, FL 32405
Hurst, Morgan	Boardmember	525 East Fifteenth Street, Panama City, FL 32405
James, Oenbrink	Boardmember	525 East Fifteenth Street, Panama City, FL 32405

Board Member

Name	Role	Address
Amanda, Byers	Board Member	525 East Fifteenth Street, Panama City, FL 32405

Events

Event Type	Filed Date	Value	Description
CHANGE OF PRINCIPAL ADDRESS	2023-01-25	525 East Fifteenth Street, Panama City, FL 32405	No data
REGISTERED AGENT ADDRESS CHANGED	2023-01-25	525 East Fifteenth Street, Panama City, FL 32405	No data
CHANGE OF MAILING ADDRESS	2023-01-25	525 East Fifteenth Street, Panama City, FL 32405	No data
AMENDMENT	2017-08-31	No data	No data
REGISTERED AGENT NAME CHANGED	2013-02-04	AILES, EDWIN R	No data
CANCEL ADM DISS/REV	2009-11-05	No data	No data
ADMIN DISSOLUTION FOR ANNUAL REPORT	2009-09-25	No data	No data
CORPORATE MERGER	1998-06-03	No data	CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. CORPORATE MERGER NUMBER 500000018345
CORPORATE MERGER	1996-06-05	No data	CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. CORPORATE MERGER NUMBER 300000010113
NAME CHANGE AMENDMENT	1988-01-05	LIFE MANAGEMENT CENTER OF NORTHWEST FLORIDA, INC.	No data

Documents

Name	Date
ANNUAL REPORT	2024-02-02
ANNUAL REPORT	2023-01-25
ANNUAL REPORT	2022-01-24
ANNUAL REPORT	2021-02-16
ANNUAL REPORT	2020-03-19
ANNUAL REPORT	2019-03-05
ANNUAL REPORT	2018-03-30
Amendment	2017-08-31
ANNUAL REPORT	2017-05-02
ANNUAL REPORT	2016-04-06
ANNUAL REPORT	2015-04-23
ANNUAL REPORT	2014-04-25
ANNUAL REPORT	2013-02-04
ANNUAL REPORT	2012-02-07
ANNUAL REPORT	2011-02-15
ANNUAL REPORT	2010-05-01
REINSTATEMENT	2009-11-05
ANNUAL REPORT	2008-01-14
ANNUAL REPORT	2007-01-16
ANNUAL REPORT	2006-04-12

Date of last update: 06 Feb 2025

Sources: Florida Department of State