| Entity Name: | LIBERTY COMMUNITY HEALTH CARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 30 Nov 2006 (18 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | N06000012303 |
| FEI/EIN Number | 38-3889502 |
| Address: | 17316 NE SR 65, HOSFORD, FL, 32334, US |
| Mail Address: | P.O. BOX 175, Hosford, FL, 32334, US |
| ZIP code: | 32334 |
| County: | Liberty |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962875435 | 2015-11-05 | 2017-01-04 | 17316 NE STATE ROAD 65, HOSFORD, FL, 323342415, US | 17316 NE STATE ROAD 65, HOSFORD, FL, 323342415, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 850-379-5800 |
| Fax | 8503795811 |
Authorized person
| Name | MRS. PEGGY DEASON HOWLAND |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 8503795800 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | OS7759 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016050000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Howland Peggy D | Agent | 20277 NE Hentz Ave, Blountstown, FL, 32424 |
| Name | Role | Address |
|---|---|---|
| Clark Michael | Chairman | P.O. BOX 175, Hosford, FL, 32334 |
| Meeks Heber | Chairman | P.O. BOX 175, Hosford, FL, 32334 |
| Name | Role | Address |
|---|---|---|
| Meeks Heber | Co | P.O. BOX 175, Hosford, FL, 32334 |
| Name | Role | Address |
|---|---|---|
| Money Walter | Treasurer | P.O. BOX 175, Hosford, FL, 32334 |
| Name | Role | Address |
|---|---|---|
| FORD STEPHEN | Secretary | 17316 NE SR 65, Hosford, FL, 32334 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-30 | Howland, Peggy Deason | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-04-01 | 20277 NE Hentz Ave, Blountstown, FL 32424 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-10-14 | 17316 NE SR 65, HOSFORD, FL 32334 | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-21 | 17316 NE SR 65, HOSFORD, FL 32334 | No data |
| AMENDMENT | 2009-07-02 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-04-07 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-02-17 |
| ANNUAL REPORT | 2016-04-01 |
| ANNUAL REPORT | 2015-03-04 |
| ANNUAL REPORT | 2014-02-24 |
| AMENDED ANNUAL REPORT | 2013-03-11 |
| ANNUAL REPORT | 2013-02-21 |
| ANNUAL REPORT | 2012-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
