| Entity Name: | PHOENIX FAMILY HEALTH CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 30 Aug 2011 (13 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 16 Dec 2022 (2 years ago) |
| Document Number: | N11000008229 |
| FEI/EIN Number | 45-3046311 |
| Address: | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Mail Address: | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| ZIP code: | 32322 |
| County: | Franklin |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063798478 | 2011-10-30 | 2012-10-02 | 1581 HIGHWAY 98 W, CARRABELLE, FL, 323225009, US | 1581 HIGHWAY 98 W, CARRABELLE, FL, 323225009, US | |||||||||||||||||||||||||
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| Phone | +1 850-697-3420 |
| Fax | 8506973423 |
Authorized person
| Name | DR. LOIS MARIE MENDEZ CATLIN |
| Role | VP BUSINESS MANAGER |
| Phone | 8506973420 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ACN212 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 275192500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MENDEZ CATLIN, Lois | Agent | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| MENDEZ CATLIN, SEAN, Esq. | President | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| MENDEZ CATLIN, LOIS M, Dr. | President | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| MENDEZ CATLIN, LOIS M, Dr. | Vice President | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| MENDEZ CATLIN, LOIS M, Dr. | Officer | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| MENDEZ CATLIN, LOIS M, Dr. | CEBO | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| CATLIN, LIONEL B, Dr. | Manager | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| CATLIN, LIONEL B, Dr. | Director | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| THOMPSON, JACQUELINE | Chairman | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| THOMPSON, JACQUELINE | Secretary | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| WHEELESS, DENISE, Esq. | LA | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| Walker, David, Rev | Community Liaison | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| Cupid, Andrea | Youth Advocate | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Dempsey, Jessica | Youth Advocate | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Name | Role | Address |
|---|---|---|
| Daniels, RosaMae | Patient Advocate | 1581 WEST HWY 98, CARRABELLE, FL 32322 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2022-12-16 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| REINSTATEMENT | 2019-10-21 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REINSTATEMENT | 2017-10-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-04-15 | MENDEZ CATLIN, Lois | No data |
| AMENDMENT | 2015-04-15 | No data | No data |
| REINSTATEMENT | 2012-10-18 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-06-06 |
| ANNUAL REPORT | 2023-05-22 |
| REINSTATEMENT | 2022-12-16 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-02-04 |
| REINSTATEMENT | 2019-10-21 |
| ANNUAL REPORT | 2018-08-07 |
| REINSTATEMENT | 2017-10-12 |
| ANNUAL REPORT | 2016-03-19 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
