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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
Date Filed: 24 Oct 2014 (11 years ago)
Date of dissolution: 24 Sep 2024 (10 months ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 24 Sep 2024 (10 months ago)
Document Number: N14000009925
FEI/EIN Number 47-2180518
Mail Address: 485 N. KELLER ROAD, MAITLAND, FL, 32751, US
Address: 4501 Waterman Way, Tavares, FL, 32778, US
ZIP code: 32778
City: Tavares
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 Jul 2025

Sources: Florida Department of State