| 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 (7 months ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 24 Sep 2024 (7 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 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437640471 | 2018-05-25 | 2023-11-27 | 900 HOPE WAY, ALTAMONTE SPRINGS, FL, 327141502, US | 4501 WATERMAN WAY, TAVARES, FL, 32778, US | |||||||||||||||||||||||||
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| Phone | +1 407-975-3000 |
| Fax | 4079753090 |
| Phone | +1 352-609-4000 |
Authorized person
| Name | MR. DAVID RODMAN |
| Role | ASST SECRETARY OF THE BOARD |
| Phone | 4079753011 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100964700 |
| State | FL |
| 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 |
| 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 |
| 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 | - |
| 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 |
| EIN | Type of Organization | Exempt Organization Status | Address | Ruling Date | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 47-2180518 | Association | Unconditional Exemption | 900 HOPE WAY, ALTAMONTE SPG, FL, 32714-1502 | 1947-04 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 202212 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 202112 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 202112 |
| Filing Type | E |
| Return Type | 990T |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 202012 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 201912 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 201812 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 201712 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
| Organization Name | FOUNTAIN INN NURSING AND REHABILITATION CENTER INC |
| EIN | 47-2180518 |
| Tax Period | 201612 |
| Filing Type | E |
| Return Type | 990 |
| File | View File |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
