| Entity Name: | HENDRY-GLADES MENTAL HEALTH CLINIC, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 25 Jul 1974 (50 years ago) |
| Document Number: | 730286 |
| FEI/EIN Number | 591558636 |
| Address: | 601 W. ALVERDEZ AVENUE, CLEWISTON, FL, 33440, US |
| Mail Address: | 601 W. ALVERDEZ AVENUE, CLEWISTON, FL, 33440, US |
| ZIP code: | 33440 |
| County: | Hendry |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588758478 | 2006-10-03 | 2009-12-17 | 601 W ALVERDEZ AVE, CLEWISTON, FL, 334403504, US | 601 W ALVERDEZ AVE, CLEWISTON, FL, 334403504, US | |||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 863-983-1423 |
| Fax | 8639831426 |
Authorized person
| Name | MR. JOSEPH F. HOSICK JR. |
| Role | CEO / CFO |
| Phone | 8639831423 |
Taxonomy
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 0822AD8636-00 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| License Number | 0826AD8636-01 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 060555700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060555701 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060555703 |
| State | FL |
| Issuer | MEDICAID |
| Number | 060555702 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOSICK JOSEPH | Agent | 601 WEST ALVERDEZ, CLEWISTON, FL, 33440 |
| Name | Role | Address |
|---|---|---|
| Williams Raymond D | President | 410 East Osceola Ave., CLEWISTON, FL, 33440 |
| Name | Role | Address |
|---|---|---|
| VALIANT MARTHA M | Secretary | 570 CAPTAIN HENDRY DRIVE, LABELLE, FL, 33935 |
| Name | Role | Address |
|---|---|---|
| SHUPE CHRISTOPHER | Treasurer | 205 SOUTH W.C. OWEN AVE, CLEWISTON, FL, 33440 |
| Name | Role | Address |
|---|---|---|
| Duke Mara | Vice President | 431 W. Crescent Dr., Clewiston, FL, 33440 |
| Name | Role | Address |
|---|---|---|
| Hosick Joseph FJr. | Chief Executive Officer | 1114 Riverbend Dr., LaBelle, FL, 33935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2016-07-22 | No data | No data |
| REINSTATEMENT | 2001-10-15 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2001-09-21 | No data | No data |
| AMENDMENT | 1998-08-28 | No data | No data |
| AMENDMENT | 1991-09-20 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J10000910494 | TERMINATED | 006122547 | HENDRY | 2012-12-16 | 2020-09-15 | $ 377.63 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, FORT MYERS SERVICE CENTER, 2295 VICTORIA AVE STE 270, FORT MYERS FL339013871 |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
