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NORTHEAST FLORIDA HEALTH SERVICES, INC. - Florida Company Profile

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Company Details

Entity Name: NORTHEAST FLORIDA HEALTH SERVICES, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Active

The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness.

Date Filed: 25 Sep 2002 (23 years ago)
Document Number: N02000004883
FEI/EIN Number 550799729

Federal Employer Identification (FEI) Number assigned by the IRS.

Address: 1205 S. WOODLAND BLVD, DeLand, FL, 32720, US
Mail Address: 1205 S. WOODLAND BLVD, DeLand, FL, 32720, US
ZIP code: 32720
City: Deland
County: Volusia
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
Asbury Laurie Agent 1205 S. Woodland Blvd, DeLand, FL, 32720
Asbury Laurie Chief Executive Officer 1205 S. Woodland Blvd., DeLand, FL, 32720
Valdez Hipolito Chief Financial Officer 1205 S. WOODLAND BLVD, DeLand, FL, 32720
Cambell Vivian Chairman 1205 S. WOODLAND BLVD, DeLand, FL, 32720
Rodriguez Robert Director 1205 S. WOODLAND BLVD, DeLand, FL, 32720

Unique Entity ID

A UEI is a government-provided number, like a tax ID number, that’s used to identify businesses eligible for federal grants, awards and contracts.

Note: In April 2022, the federal government replaced its old identifier of choice, the Data Universal Numbering System (DUNS) number, with a government-issued UEI. Now all the federal government’s Integrated Award Environment systems use UEI numbers instead of DUNS numbers. So any entity doing business with the federal government must register for a UEI.

CAGE Code:
4FD40
UEI Expiration Date:
2020-09-05

Business Information

Doing Business As:
FAMILY HEALTH SOURCE
Activation Date:
2019-09-06
Initial Registration Date:
2006-06-09

Commercial and government entity program

The The Commercial And Government Entity Code (CAGE) is assigned by the Department of Defense's Defense Logistics Agency (DLA) and represents your company's physical address for GSA's mailings, payments, and administrative records.

Note: A CAGE Code enables a company to contract with the U.S. government, allowing bid on government contracts and to receive government payments. Also for business this means that it's a Verified business entity and Has a validated physical address.

CAGE number:
4FD40
Status:
Obsolete
Type:
Non-Manufacturer
CAGE Update Date:
2024-11-20
SAM Expiration:
2025-11-14

Contact Information

POC:
LORETTA ASBURY

National Provider Identifier

NPI Number:
1609543594
Certification Date:
2021-08-10

Authorized Person:

Name:
REBECCA COLLIER
Role:
CREDENTIALING/CONTRACTS ADMIN.
Phone:

Taxonomy:

Selected Taxonomy:
261QF0400X - Federally Qualified Health Center (FQHC)
Is Primary:
No
Selected Taxonomy:
207Q00000X - Family Medicine Physician
Is Primary:
Yes

Contacts:

Fax:
3862231799

Form 5500 Series

Employer Identification Number (EIN):
550799729
Plan Year:
2020
Number Of Participants:
84
Sponsors Telephone Number:
Plan Year:
2020
Number Of Participants:
84
Sponsors Telephone Number:
Plan Year:
2019
Number Of Participants:
96
Sponsors DBA Name:
FAMILY HEALTH SOURCE
Sponsors Telephone Number:
Plan Year:
2018
Number Of Participants:
82
Sponsors DBA Name:
FAMILY HEALTH SOURCE
Sponsors Telephone Number:

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G16000025800 FAMILY HEALTH SOURCE EXPIRED 2016-03-10 2021-12-31 - P.O. BOX 527, PIERSON, FL, 32180
G10000028767 FAMILY HEALTH SOURCE EXPIRED 2010-03-30 2015-12-31 - P.O. BOX 527, PIERSON, FL, 32180
G08162900346 DELAND MEDICAL CENTER EXPIRED 2008-06-10 2013-12-31 - P.O. BOX 527, PIERSON, FL, 32180

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2025-01-28 1205 S. WOODLAND BLVD, Suite 3, DeLand, FL 32720 -
CHANGE OF MAILING ADDRESS 2025-01-28 1205 S. WOODLAND BLVD, Suite 3, DeLand, FL 32720 -
REGISTERED AGENT ADDRESS CHANGED 2025-01-28 1205 S. Woodland Blvd, Suite 3, DeLand, FL 32720 -
REGISTERED AGENT NAME CHANGED 2015-03-12 Asbury, Laurie -

Documents

Name Date
ANNUAL REPORT 2025-01-28
ANNUAL REPORT 2024-01-10
ANNUAL REPORT 2023-02-08
ANNUAL REPORT 2022-02-03
AMENDED ANNUAL REPORT 2021-09-15
ANNUAL REPORT 2021-01-05
ANNUAL REPORT 2020-01-06
ANNUAL REPORT 2019-02-13
ANNUAL REPORT 2018-03-21
ANNUAL REPORT 2017-03-14

USAspending Awards / Financial Assistance

Date:
2023-08-29
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 BRIDGE ACCESS PROGRAM
Obligated Amount:
0.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2023-05-05
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2023 EXPANDING COVID-19 VACCINATION
Obligated Amount:
0.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-09-20
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
HEALTH CENTER INFRASTRUCTURE SUPPORT
Obligated Amount:
654187.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-03-27
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
AMERICAN RESCUE PLAN ACT FUNDING FOR HEALTH CENTERS
Obligated Amount:
3080283.18
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2020-05-05
Awarding Agency Name:
Department of Health and Human Services
Transaction Description:
FY 2020 EXPANDING CAPACITY FOR CORONAVIRUS TESTING (ECT)
Obligated Amount:
308584.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00

Tax Exempt

Employer Identification Number (EIN) :
55-0799729
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
2004-02
National Taxonomy Of Exempt Entities:
Health Care: Community Health Systems
Deductibility:
Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Paycheck Protection Program

Jobs Reported:
86
Initial Approval Amount:
$731,900
Date Approved:
2020-04-09
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$887,000
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$892,519.11
Servicing Lender:
Truist Bank
Use of Proceeds:
Payroll: $887,000

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Date of last update: 02 Jul 2025

Sources: Florida Department of State