Entity Name: | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. |
Jurisdiction: | FLORIDA |
Filing Type: | Domestic Non-Profit |
Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
Date Filed: | 17 Oct 1980 (44 years ago) |
Date of dissolution: | 06 Jan 2014 (11 years ago) |
Last Event: | CORPORATE MERGER |
Event Date Filed: | 06 Jan 2014 (11 years ago) |
Document Number: | 754720 |
FEI/EIN Number |
592086283
Federal Employer Identification (FEI) Number assigned by the IRS. |
Address: | 173 ALBRITTON LN, LAKE CITY, FL, 32055, US |
Mail Address: | P O BOX 249, LAKE CITY, FL, 32056-7249 |
ZIP code: | 32055 |
County: | Columbia |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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1962464248 | 2006-04-04 | 2010-10-15 | PO BOX 249, LAKE CITY, FL, 320560249, US | 173 NW ALBRITTON LN, LAKE CITY, FL, 320550249, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Phone | +1 386-758-5552 |
Fax | 3867529143 |
Authorized person
Name | MR. JOHN T MYLES |
Role | CEO |
Phone | 3867585552 |
Taxonomy
Taxonomy Code | 207Q00000X - Family Medicine Physician |
License Number | ME92183 |
State | FL |
Is Primary | No |
Taxonomy Code | 261Q00000X - Clinic/Center |
License Number | 5080000065 |
State | FL |
Is Primary | Yes |
Taxonomy Code | 363A00000X - Physician Assistant |
License Number | PA0003548 |
State | FL |
Is Primary | No |
Taxonomy Code | 363A00000X - Physician Assistant |
License Number | PA9101298 |
State | FL |
Is Primary | No |
Taxonomy Code | 363L00000X - Nurse Practitioner |
License Number | 1181972 |
State | FL |
Is Primary | No |
Taxonomy Code | 363L00000X - Nurse Practitioner |
License Number | ARNP2908802 |
State | FL |
Is Primary | No |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 023552300 |
State | FL |
Issuer | MEDICAID |
Number | 292277100 |
State | FL |
Issuer | STATE LICENSE |
Number | ME92183 |
State | FL |
Issuer | MEDICAID |
Number | 033364600 |
State | FL |
Issuer | FLORIDA LICENSE |
Number | PA9101298 |
State | FL |
Issuer | ORIGINAL LICENSE |
Number | 5080000065 |
State | FL |
Issuer | FLORIDA LICENSE |
Number | PA0003548 |
State | FL |
Issuer | FLORIDA LICENSE |
Number | 1181972 |
State | FL |
Issuer | MEDICAID |
Number | 273713200 |
State | FL |
Issuer | MEDICAID |
Number | 290374100 |
State | FL |
Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
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FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. 403(B) | 2011 | 592086283 | 2013-04-22 | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. | 22 | |||||||||||||||||||||||||||||||||||||||||
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Administrator’s EIN | 592086283 |
Plan administrator’s name | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. |
Plan administrator’s address | P.O. BOX 249, LAKE CITY, FL, 32056 |
Administrator’s telephone number | 3867554020 |
Signature of
Role | Plan administrator |
Date | 2013-04-22 |
Name of individual signing | JOHN MYLES |
Valid signature | Filed with authorized/valid electronic signature |
Role | Employer/plan sponsor |
Date | 2013-04-22 |
Name of individual signing | JOHN MYLES |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1987-10-01 |
Business code | 621498 |
Sponsor’s telephone number | 3867554020 |
Plan sponsor’s address | P.O. BOX 249, LAKE CITY, FL, 32056 |
Plan administrator’s name and address
Administrator’s EIN | 592086283 |
Plan administrator’s name | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. |
Plan administrator’s address | P.O. BOX 249, LAKE CITY, FL, 32056 |
Administrator’s telephone number | 3867554020 |
Signature of
Role | Plan administrator |
Date | 2012-04-27 |
Name of individual signing | JOHN MYLES |
Valid signature | Filed with authorized/valid electronic signature |
File | View Page |
Three-digit plan number (PN) | 001 |
Effective date of plan | 1987-10-01 |
Business code | 621498 |
Sponsor’s telephone number | 3867554020 |
Plan sponsor’s address | P.O. BOX 249, LAKE CITY, FL, 320560249 |
Plan administrator’s name and address
Administrator’s EIN | 592086283 |
Plan administrator’s name | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. |
Plan administrator’s address | P.O. BOX 249, LAKE CITY, FL, 320560249 |
Administrator’s telephone number | 3867554020 |
Signature of
Role | Plan administrator |
Date | 2011-04-14 |
Name of individual signing | JOHN MYLES |
Valid signature | Filed with authorized/valid electronic signature |
Name | Role | Address |
---|---|---|
PATTISON DOROTHY | Vice President | 576 NW SPRING HOLLOW BLVD, LAKE CITY, FL, 32055 |
HERDEGEN BETTY | Secretary | 245 SE RACHEL WAY, LAKE CITY, FL, 32025 |
ALBURY PATRICIA A | Treasurer | 21298 S. US HWY.441, HIGH SPRINGS,, FL, 32346 |
SCHAAFSMA C. KEITH | President | 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054 |
SCHAAFSMA C. KEITH | Director | 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054 |
SCHAAFSMA C. KEITH | Agent | 4451 SW 102ND AVE., LAKE BUTLER, FL, 32054 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
MERGER | 2014-01-06 | - | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS N24356. MERGER NUMBER 900000137389 |
REGISTERED AGENT NAME CHANGED | 2011-01-24 | SCHAAFSMA, C. KEITH | - |
REGISTERED AGENT ADDRESS CHANGED | 2011-01-24 | 4451 SW 102ND AVE., LAKE BUTLER, FL 32054 | - |
CHANGE OF PRINCIPAL ADDRESS | 2007-04-02 | 173 ALBRITTON LN, LAKE CITY, FL 32055 | - |
CHANGE OF MAILING ADDRESS | 1992-03-26 | 173 ALBRITTON LN, LAKE CITY, FL 32055 | - |
NAME CHANGE AMENDMENT | 1986-06-19 | FAMILY HEALTH CENTER OF COLUMBIA COUNTY, INC. | - |
Name | Date |
---|---|
ANNUAL REPORT | 2013-02-06 |
ANNUAL REPORT | 2012-02-02 |
ANNUAL REPORT | 2011-01-24 |
ANNUAL REPORT | 2010-05-21 |
ANNUAL REPORT | 2010-01-26 |
ANNUAL REPORT | 2009-02-26 |
ANNUAL REPORT | 2008-03-03 |
ANNUAL REPORT | 2007-04-02 |
ANNUAL REPORT | 2006-03-01 |
ANNUAL REPORT | 2005-04-08 |
FAIN | Awarding Agency | Assistance Listings | Start Date | End Date | Description | |||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
C81CS13700 | Department of Health and Human Services | 93.703 - ARRA – GRANTS TO HEALTH CENTER PROGRAMS | 2009-06-29 | 2011-06-28 | ARRA - CAPITAL IMPROVEMENT PROGRAM | |||||||||||||||||||||
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H80CS00545 | Department of Health and Human Services | 93.224 - CONSOLIDATED HEALTH CENTERS (COMMUNITY HEALTH CENTERS, MIGRANT HEALTH CENTERS, HEALTH CARE FOR THE HOMELESS, PUBLIC HOUSING PRIMARY CARE, AND SCHOOL BASED HEALTH CENTERS) | 2002-06-01 | 2009-05-31 | HEALTH CENTER CLUSTER | |||||||||||||||||||||
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Date of last update: 01 Mar 2025
Sources: Florida Department of State