| Entity Name: | BRAIN DISORDER SUPPORT FOUNDATION, 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: | 29 Sep 2004 (21 years ago) |
| Date of dissolution: | 17 Jan 2018 (7 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 17 Jan 2018 (7 years ago) |
| Document Number: | N04000009297 |
| FEI/EIN Number |
800113224
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 353 JUNIPER LAKE RD., DEFUNIAK SPRINGS, FL, 32433 |
| Mail Address: | 353 JUNIPER LAKE RD., DEFUNIAK SPRINGS, FL, 32433 |
| ZIP code: | 32433 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558618454 | 2012-08-09 | 2012-08-09 | 353 JUNIPER LAKE RD, DEFUNIAK SPRINGS, FL, 324333514, US | 353 JUNIPER LAKE RD, DEFUNIAK SPRINGS, FL, 324333514, US | |||||||||||||||||||||||||
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| Phone | +1 850-892-0565 |
| Fax | 8505204651 |
Authorized person
| Name | MRS. HILDA R COURSEY |
| Role | ADMINISTRATOT |
| Phone | 8508920565 |
Taxonomy
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| License Number | AHCA #9115 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FL AHCA LICENSE |
| Number | 9115 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Silvia Jacqueline M | Chief Executive Officer | 353 JUNIPER LAKE RD, DEFUNIAK SPRINGS, FL, 32433 |
| Kelley Ron | Director | 186 Clay Street, DEFUNIAK SPRINGS, FL, 32435 |
| White Wayne | Chairman | 80 Guava Ave., DeFuniak Springs, FL, 32433 |
| Garcia Ruben | Director | 518 McCullough Road, DeFuniak Springs, FL, 32435 |
| Lindsey Bob | Director | 968 Hill St., DeFuniak Springs, FL, 32435 |
| Silvia Jacqueline M | Agent | 353 Juniper Lake Road, DEFUNIAK SPRINGS, FL, 32433 |
| Mosley Cathy M | Director | 3089 Co. Highway 183-B, DeFuniak Springs, FL, 32435 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000102394 | FRIENDSHIP HOUSE BDSF | EXPIRED | 2009-04-30 | 2014-12-31 | - | 353 JUNIPER LAKE RD., DEFUNIAK SPRINGS, FL, 32433 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2018-01-17 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | - | - |
| REGISTERED AGENT NAME CHANGED | 2016-04-04 | Silvia, Jacqueline M | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-06-10 | 353 Juniper Lake Road, DEFUNIAK SPRINGS, FL 32433 | - |
| REINSTATEMENT | 2010-10-27 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2009-06-01 | 353 JUNIPER LAKE RD., DEFUNIAK SPRINGS, FL 32433 | - |
| CHANGE OF MAILING ADDRESS | 2009-06-01 | 353 JUNIPER LAKE RD., DEFUNIAK SPRINGS, FL 32433 | - |
| NAME CHANGE AMENDMENT | 2008-03-17 | BRAIN DISORDER SUPPORT FOUNDATION, INC. | - |
| AMENDMENT | 2006-02-07 | - | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000260580 | LAPSED | 16-223-1A | LEON | 2017-03-10 | 2022-05-11 | $2,587.46 | DFS DIVISION OF WORKERS COMPENSATION, 200 EAST GAINES STREET, TALLAHASSEE, FL 32399-4228 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-05-01 |
| ANNUAL REPORT | 2014-06-10 |
| ANNUAL REPORT | 2013-04-08 |
| ANNUAL REPORT | 2012-02-17 |
| ANNUAL REPORT | 2011-04-20 |
| REINSTATEMENT | 2010-10-27 |
| ANNUAL REPORT | 2009-06-01 |
| ANNUAL REPORT | 2008-04-24 |
| Name Change | 2008-03-17 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
