| Entity Name: | HEALTHPARK CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 31 Jul 1991 (34 years ago) |
| Document Number: | N44499 |
| FEI/EIN Number | 650319983 |
| Address: | 16131 ROSERUSH COURT, FT MYERS, FL, 33908, US |
| Mail Address: | 2776 CLEVELAND AVENUE, LEGAL MOC 459, FT MYERS, FL, 33901, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699786061 | 2006-08-11 | 2015-08-26 | 16131 ROSERUSH CT, FORT MYERS, FL, 339083634, US | 16131 ROSERUSH CT, FORT MYERS, FL, 339083634, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 239-433-4647 |
| Fax | 2394323456 |
Authorized person
| Name | MR. TROY CHURCHILL |
| Role | ADMINISTRATOR |
| Phone | 2393437300 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1202096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 021058700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCGILLICUDDY MARY | Agent | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| ALLEN DANE | Secretary | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| CLARKE DONNA | Chairman | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| KLEIN DAVID | Vice Chairman | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| COLLINS DAVID | Treasurer | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G92273000185 | HEALTHPARK CARE CENTER | ACTIVE | 1992-09-29 | 2027-12-31 | No data | 16131 ROSERUSH COURT, FORT MYERS, FL, 33908, US |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2024-10-30 | No data | No data |
| AMENDMENT | 2002-09-20 | No data | No data |
| AMENDMENT | 1992-09-17 | No data | No data |
| NAME CHANGE AMENDMENT | 1991-11-20 | HEALTHPARK CARE CENTER, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
