| Entity Name: | CENTRAL FLORIDA CHILD HEALTH PROGRAM, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Active |
| Date Filed: | 13 Sep 1991 (33 years ago) |
| Last Event: | AMENDMENT AND NAME CHANGE |
| Event Date Filed: | 26 Mar 2009 (16 years ago) |
| Document Number: | N45127 |
| FEI/EIN Number | 59-3084109 |
| Address: | 1802 South Fiske Blvd, 105, Rockledge, FL 32955 |
| Mail Address: | 9300 Conroy Windermere Rd #2722, Windermere, FL 34786 |
| ZIP code: | 32955 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558446963 | 2006-10-25 | 2011-04-05 | 7040 LAKE ELLENOR DRIVE, ORLANDO, FL, 328095750, US | 7040 LAKE ELLENOR DRIVE, ORLANDO, FL, 328095750, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Phone | +1 407-858-6143 |
| Fax | 4078566594 |
Authorized person
| Name | MRS. CATHLEEN O. MARK |
| Role | PROJECT ADMINISTRATOR |
| Phone | 4078586143 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 056105302 |
| State | FL |
| Name | Role |
|---|---|
| CENTRAL FLORIDA CHILD HEALTH PROGRAM, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| Amos, Jacqueline A | Executive Director | 9300 Conroy Windermere Rd, #2722 Windermere, FL 34786 |
| Name | Role | Address |
|---|---|---|
| Mehta, Naina, Dr. | Officer | 3800 Lower Park Rd, Orlando, FL 32814 |
| Kerr, Dermott | Officer | 2407 Black Powder Lane, Kissimmee, FL 34743 |
| Leonard-Woods, Linda | Officer | 9300 Conroy Windermere Rd, #2722 Windermere, FL 34786 |
| Name | Role | Address |
|---|---|---|
| Mehta, Devendra | Board President | 3800 Lower Park Rd, ORLANDO, FL 32814 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-18 | 1370 Sarno Rd,, F, Melbourne, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-19 | 1802 South Fiske Blvd, 105, Rockledge, FL 32955 | No data |
| REGISTERED AGENT NAME CHANGED | 2022-01-31 | Central Florida Child Health Program, Inc | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-11 | 1802 South Fiske Blvd, 105, Rockledge, FL 32955 | No data |
| AMENDMENT AND NAME CHANGE | 2009-03-26 | CENTRAL FLORIDA CHILD HEALTH PROGRAM, INC. | No data |
| AMENDMENT | 1992-03-09 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-18 |
| ANNUAL REPORT | 2023-01-19 |
| ANNUAL REPORT | 2022-01-31 |
| ANNUAL REPORT | 2021-01-11 |
| ANNUAL REPORT | 2020-01-07 |
| ANNUAL REPORT | 2019-01-15 |
| ANNUAL REPORT | 2018-01-08 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-08 |
| ANNUAL REPORT | 2015-01-05 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
