| Entity Name: | THE GOOD SAMARITAN FREE CLINIC, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 12 Sep 2012 (12 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: | N12000008733 |
| FEI/EIN Number | 46-0970320 |
| Address: | 2601 VIRGINIA AVENUE, FORT PIERCE, FL 34981 |
| Mail Address: | P.O. Box 12144, Fort Pierce, FL 34979 |
| ZIP code: | 34981 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760802458 | 2014-04-21 | 2014-04-21 | PO BOX 3035, FORT PIERCE, FL, 349483035, US | 2601 VIRGINIA AVE, FORT PIERCE, FL, 349815539, US | |||||||||||||||||
|
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| Phone | +1 772-924-1137 |
Authorized person
| Name | EVA BRYANT |
| Role | EXECUTIVE ASSISTANT |
| Phone | 7728799383 |
Taxonomy
| Taxonomy Code | 302R00000X - Health Maintenance Organization |
| License Number | RN9338409 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| BRYANT, EVA | Agent | 566 SW ASTER ROAD, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| MYLES, COLLIN | Chair Person | 1205 EGRET AVENUE, FORT PIERCE, FL 34982 |
| Name | Role | Address |
|---|---|---|
| Phillip, Jennifer C | Administrator | 3237 SW Constellation Road, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| Bryant, Eva | Treasurer | 566 SW Aster Rd, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| HYLTON, MURIEL | Secretary | 1001 SW FENWAY ROAD, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| BRYANT, GEORGE | Board Member | 566 SW ASTER ROAD, PORT ST LUCIE, FL 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-26 | 2601 VIRGINIA AVENUE, FORT PIERCE, FL 34981 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-03-01 |
| ANNUAL REPORT | 2019-04-13 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-03-26 |
| ANNUAL REPORT | 2016-02-01 |
| ANNUAL REPORT | 2015-01-19 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-02-20 |
| Domestic Non-Profit | 2012-09-12 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
