| Entity Name: | SOUTH WALTON ACADEMY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 05 Feb 2016 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 30 Oct 2020 (4 years ago) |
| Document Number: | N16000001226 |
| FEI/EIN Number | 37-1802451 |
| Address: | 305 MACK BAYOU ROAD, SANTA ROSA BEACH, FL, 32459 |
| Mail Address: | 305 MACK BAYOU ROAD, SANTA ROSA BEACH, FL, 32459 |
| ZIP code: | 32459 |
| County: | Walton |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568964278 | 2018-03-08 | 2021-01-25 | 305 MACK BAYOU RD, SANTA ROSA BEACH, FL, 324597199, US | 305 MACK BAYOU RD, SANTA ROSA BEACH, FL, 324597199, US | |||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-213-4595 |
| Fax | 8502134596 |
Authorized person
| Name | MRS. CALLEY G MIDDLEBROOKS |
| Role | DEVELOPMENTAL THERAPIST |
| Phone | 8502134595 |
Taxonomy
| Taxonomy Code | 103K00000X - Behavior Analyst |
| Is Primary | No |
| Taxonomy Code | 106S00000X - Behavior Technician |
| Is Primary | No |
| Taxonomy Code | 225100000X - Physical Therapist |
| Is Primary | No |
| Taxonomy Code | 225X00000X - Occupational Therapist |
| Is Primary | No |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | No |
| Taxonomy Code | 261Q00000X - Clinic/Center |
| Is Primary | Yes |
| Taxonomy Code | 261QM1300X - Multi-Specialty Clinic/Center |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1255535597 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Filippone Jennifer | Agent | 379 Pelican Bay Drive, Santa Rosa Beach, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| Filippone Jennifer | Director | 379 Pelican Bay Drive, Santa Rosa Beach, FL, 32459 |
| GODBOLD EDWARD LJR | Director | 405 Paradise Blvd, Panama City BEACH, FL, 32413 |
| Name | Role | Address |
|---|---|---|
| Middlebrooks Calley | President | 732 Wild Heron Way, Panama City Beach, FL, 32413 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-30 | 379 Pelican Bay Drive, Santa Rosa Beach, FL 32459 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-03-04 | Filippone, Jennifer | No data |
| REINSTATEMENT | 2020-10-30 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2020-07-01 | 305 MACK BAYOU ROAD, SANTA ROSA BEACH, FL 32459 | No data |
| AMENDMENT | 2020-07-01 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2020-07-01 | 305 MACK BAYOU ROAD, SANTA ROSA BEACH, FL 32459 | No data |
| AMENDMENT | 2017-07-10 | No data | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-12-05 |
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-04-06 |
| REINSTATEMENT | 2020-10-30 |
| Amendment | 2020-07-01 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-03-02 |
| Amendment | 2017-07-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
