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FOUNTAIN INN NURSING & REHABILITATION CENTER, INC. - Florida Company Profile

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Company Details

Entity Name: FOUNTAIN INN NURSING & REHABILITATION CENTER, 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: 24 Oct 2014 (11 years ago)
Date of dissolution: 24 Sep 2024 (9 months ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 24 Sep 2024 (9 months ago)
Document Number: N14000009925
FEI/EIN Number 47-2180518

Federal Employer Identification (FEI) Number assigned by the IRS.

Mail Address: 485 N. KELLER ROAD, MAITLAND, FL, 32751, US
Address: 4501 Waterman Way, Tavares, FL, 32778, US
ZIP code: 32778
County: Lake
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
ADDISCOTT LYNN Assi 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714
Stiltz Bryan Chairman 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714
RATHBUN PAUL C Assi 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714
Vincent Haney Assi 900 Hope Way, Altamonte Springs, FL, 32714
Rodman David L Director 485 N. Keller Road, Maitland, FL, 32751
Saunders Michael Assi 900 Hope Way, Altamonte Springs, FL, 32714
BROMME JEFFREY S Agent 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 32714

National Provider Identifier

NPI Number:
1437640471
Certification Date:
2023-11-27

Authorized Person:

Name:
MR. DAVID RODMAN
Role:
ASST SECRETARY OF THE BOARD
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4079753090

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000104364 ADVENTHEALTH CARE CENTER WATERMAN ACTIVE 2018-09-21 2028-12-31 - 4501 WATERMAN WAY, TAVARES, FL, 32778
G18000095466 ADVENTHEALTH TRANSITIONAL CARE WATERMAN EXPIRED 2018-08-27 2023-12-31 - 405 WATERMAN WAY, TAVARES, FL, 32778

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2024-09-24 - -
REGISTERED AGENT NAME CHANGED 2020-12-11 BROMME, JEFFREY S -
CHANGE OF PRINCIPAL ADDRESS 2018-02-01 4501 Waterman Way, Tavares, FL 32778 -
CHANGE OF MAILING ADDRESS 2015-12-04 4501 Waterman Way, Tavares, FL 32778 -

Documents

Name Date
Voluntary Dissolution 2024-10-18
Voluntary Dissolution 2024-09-24
ANNUAL REPORT 2024-07-12
AMENDED ANNUAL REPORT 2023-01-26
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-04-26
ANNUAL REPORT 2021-04-24
Reg. Agent Change 2020-12-11
ANNUAL REPORT 2020-06-22
ANNUAL REPORT 2019-04-18

Tax Exempt

Employer Identification Number (EIN) :
47-2180518
In Care Of Name:
% MICHELLE GIVENS
Classification:
Religious Organization
Ruling Date:
1947-04

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Date of last update: 02 Jun 2025

Sources: Florida Department of State