| Entity Name: | COUNTRYSIDE BIRTHING PLACE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 11 Jun 1984 (41 years ago) |
| Document Number: | H07283 |
| FEI/EIN Number | 592470258 |
| Address: | 3060 JONES LANE, CLEARWATER, FL, 33759, US |
| Mail Address: | 3060 JONES LANE, CLEARWATER, FL, 33759, US |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750497830 | 2006-08-22 | 2014-07-29 | 3060 JONES LN, CLEARWATER, FL, 337591603, US | 3060 JONES LN, CLEARWATER, FL, 337591603, US | |||||||||||||||||||||||||
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| Phone | +1 727-796-7502 |
| Fax | 7277967072 |
Authorized person
| Name | MRS. SHIRLEY J TREGILLUS |
| Role | OWNER/OPERATOR |
| Phone | 7277967502 |
Taxonomy
| Taxonomy Code | 261QB0400X - Birthing Clinic/Center |
| License Number | 337 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 011140400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TREGILLUS SHIRLEY J | Agent | 3020 JONES LN, CLEARWATER, FL, 33759 |
| Name | Role | Address |
|---|---|---|
| TREGILLUS SHIRLEY J | President | 3020 JONES LN, CLEARWATER, FL, 33759 |
| Name | Role | Address |
|---|---|---|
| TREGILLUS SHIRLEY J | Director | 3020 JONES LN, CLEARWATER, FL, 33759 |
| Name | Role | Address |
|---|---|---|
| MOORE CHRISTINA H | Secretary | 3443 Jackson Dr, Holiday, FL, 34691 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2014-12-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2013-09-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| PENDING REINSTATEMENT | 2011-08-08 | No data | No data |
| REINSTATEMENT | 2011-08-06 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| CANCEL ADM DISS/REV | 2006-03-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
