| Entity Name: | DISTRICT HOSPITAL HOLDINGS, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 25 Feb 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 23 Aug 2010 (14 years ago) |
| Document Number: | N04000002015 |
| FEI/EIN Number | 35-2226306 |
| Address: | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 |
| Mail Address: | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801885413 | 2005-10-17 | 2024-01-23 | 1515 N FLAGLER DR STE 101, WEST PALM BEACH, FL, 334013429, US | 39200 HOOKER HWY, BELLE GLADE, FL, 33430, US | |||||||||||||||||||||||||||||||||||
|
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| Phone | +1 561-659-1270 |
| Fax | 5618045629 |
| Phone | +1 561-996-6571 |
| Fax | 5619962898 |
Authorized person
| Name | MS. DARCY J. DAVIS |
| Role | CEO |
| Phone | 5616591270 |
Taxonomy
| Taxonomy Code | 282NR1301X - Rural Acute Care Hospital |
| License Number | 3992 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS |
| Number | 227 |
| State | FL |
| Issuer | MEDICAID |
| Number | 010144300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Icaza, Bernabe | Agent | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| O'Bannon, Sean | Vice Chairman | 1515 N. Flagler Dr., Suite 101 West Palm beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| Vidueira, Carlos | Chairman | 1515 N. Flagler Dr., Suite 101 West Palm beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| Caruso, Tracy | Director | 1515 N. Flagler Dr., Suite 101 West Palm beach, FL 33401 |
| Rooney, Patrick | Director | 1515 N. Flagler Dr., Suite 101 WEST PALM BEACH, FL 33401 |
| Gunta, Jyothi, Dr. | Director | 1515 N. Flagler Dr., Suite 101 WEST PALM BEACH, FL 33401 |
| Ward, Cathleen | Director | 1515 N. Flagler Dr., Ste. 101 West Palm Beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| Davis, Darcy J | Chief Executive Officer | 1515 N. Flagler Dr., Suite 101 West Palm beach, FL 33401 |
| Name | Role | Address |
|---|---|---|
| Johnson-Moore, Tammy | Secretary | 1515 N. Flagler Dr., Suite 101 West Palm beach, FL 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000047304 | HEALTH CARE DISTRICT LAKESIDE MEDICAL CENTER | ACTIVE | 2024-04-08 | 2029-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| G15000036815 | LAKESIDE PHYSICIAN PRACTICE | ACTIVE | 2015-04-13 | 2025-12-31 | No data | 1515 N. FLAGLER DR., STE. 101, WEST PALM BEACH, FL, 33401 |
| G09000172594 | GLADES GENERAL HOSPITAL | EXPIRED | 2010-02-03 | 2015-12-31 | No data | C/O NICHOLAS ROMANELLO, ESQ, 324 DATURA ST, SUITE 401, WEST PALM BEACH, FL, 33401 |
| G09000125526 | LAKESIDE MEDICAL GROUP | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| G09000125527 | LAKESIDE SPECIALTY GROUP | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| G09000125528 | LAKESIDE PROFESSIONAL GROUP | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PA;M BEACH, FL, 33401 |
| G09000125529 | LAKESIDE PHYSICIAN PRACTICE | EXPIRED | 2009-06-24 | 2014-12-31 | No data | C/O NICHOLAS W. ROMANELLO, ESQ., 324 DATURA STREET, WEST PALM BEACH, FL, 33401 |
| G09000125530 | LAKESIDE PRIMARY CARE ASSOCIATES | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| G09000125531 | LAKESIDE OBSTETRICAL GROUP | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| G09000125532 | LAKESIDE OB-GYN GROUP | EXPIRED | 2009-06-24 | 2024-12-31 | No data | 1515 N. FLAGLER DR., SUITE 101, WEST PALM BEACH, FL, 33401 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2022-04-12 | Icaza, Bernabe | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-01 | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-01 | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-02-01 | 1515 N. Flagler Dr., Suite 101, West Palm beach, FL 33401 | No data |
| AMENDMENT | 2010-08-23 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2009-01-06 | DISTRICT HOSPITAL HOLDINGS, INC. | No data |
| AMENDED AND RESTATEDARTICLES | 2005-04-20 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-16 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-12 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-01-21 |
| ANNUAL REPORT | 2019-02-14 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-01-06 |
| Reg. Agent Change | 2016-05-23 |
| ANNUAL REPORT | 2016-03-04 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
