| Entity Name: | GULF COUNTY SENIOR CITIZENS ASSOCIATION, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 11 Feb 1977 (48 years ago) |
| Document Number: | 738086 |
| FEI/EIN Number | 591777183 |
| Address: | 120 LIBRARY DRIVE, PORT ST JOE, FL, 32456, US |
| Mail Address: | 120 LIBRARY DR., PORT ST JOE, FL, 32456, US |
| ZIP code: | 32456 |
| County: | Gulf |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194082917 | 2012-04-18 | 2012-04-18 | 120 LIBRARY DR, PORT ST JOE, FL, 324561650, US | 120 LIBRARY DR, PORT ST JOE, FL, 324561650, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-229-8466 |
| Fax | 8502271877 |
Authorized person
| Name | MR. RUSSELL SCHOLZ |
| Role | EXECUTIVE DIRECTOR |
| Phone | 8502298466 |
Taxonomy
| Taxonomy Code | 253Z00000X - In Home Supportive Care Agency |
| License Number | 5895 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 670698300 |
| State | FL |
| Issuer | MEDICAID |
| Number | 679633800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Fields Eddie C | Agent | 120 LIBRARY DRIVE, PORT ST. JOE, FL, 32456 |
| Name | Role | Address |
|---|---|---|
| Reid Ron | President | 120 LIBRARY DRIVE, PORT ST JOE, FL, 32456 |
| Name | Role | Address |
|---|---|---|
| Fields Eddie C | Executive Director | 120 LIBRARY DR., PORT ST JOE, FL, 32456 |
| Name | Role | Address |
|---|---|---|
| Davis Pearl | Director | 120 LIBRARY DRIVE, PORT ST JOE, FL, 32456 |
| Thomas-Hudson Charlene | Director | 120 LIBRARY DR., PORT ST JOE, FL, 32456 |
| Maiben Gloria | Director | 120 Library Dr., Port St. Joe, FL, 32456 |
| Name | Role | Address |
|---|---|---|
| Hanlon Gene | Vice President | 120 LIBRARY DRIVE, PORT ST JOE, FL, 32456 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000007631 | HOMETOWN HELPERS | ACTIVE | 2017-01-20 | 2027-12-31 | No data | 120 LIBRARY DRIVE, PORT ST. JOE, FL, 32456 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
