| Entity Name: | ISLAND COAST PRIMARY CARE PROJECT INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 09 May 1994 (31 years ago) |
| Date of dissolution: | 21 Jun 2016 (9 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 21 Jun 2016 (9 years ago) |
| Document Number: | N94000002301 |
| FEI/EIN Number | 65-0489064 |
| Address: | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 |
| Mail Address: | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 |
| ZIP code: | 33916 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1003198565 | 2011-09-12 | 2011-09-12 | 4150 FORD STREET EXT STE 1B, FORT MYERS, FL, 339169498, US | 4150 FORD STREET EXT STE 1B, FORT MYERS, FL, 339169498, US | |||||||||||||||||||||
|
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| Phone | +1 239-461-8375 |
| Fax | 2394617639 |
| Phone | +1 239-467-8375 |
Authorized person
| Name | CATHY JONES |
| Role | PROGRAM ADMINISTRATOR |
| Phone | 2394618375 |
Taxonomy
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 3140N1450X - Pediatric Skilled Nursing Facility |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| SIMONSON, KATHLEEN | Agent | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 |
| Name | Role | Address |
|---|---|---|
| QUINONEZ, JORGE, Dr. | Secretary | P.O. BOX 1357, FORT MYERS, FL 33902 |
| Name | Role | Address |
|---|---|---|
| GUTTERY, EDWIN G, Dr. | Treasurer | 9350 CAMELOT DR, FORT MYERS, FL 33919 |
| Name | Role | Address |
|---|---|---|
| JONES, ERIC, Dr. | Chairman | 1450 BARCELONA AVE, FORT MYERS, FL 33901 |
| Name | Role | Address |
|---|---|---|
| TRAVIS, NANCY | MEMBER | 636 DEL PRADO BLVD, CAPE CORAL, FL 33990 |
| Name | Role | Address |
|---|---|---|
| Ritrosky, John | Board Member | 9350 Camelot Drive, Ft. Myers,, FL 33919 |
| Whitley, Steven | Board Member | P.O. Box 1020, Ft. Myers, FL 33902 |
| Valiant, Marty | Board Member | 1111 Riverbend Drive, Labelle, FL 33935 |
| Shipley, Gerald | Board Member | 13732 Pine Villa Lane, Ft. Myers, FL 33912 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2016-06-21 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2013-09-05 | SIMONSON, KATHLEEN | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2012-01-09 | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 | No data |
| CHANGE OF MAILING ADDRESS | 2012-01-09 | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-01-09 | 4150 FORD STREET EXTENSION, #1B, FORT MYERS, FL 33916 | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2016-06-21 |
| ANNUAL REPORT | 2015-01-06 |
| ANNUAL REPORT | 2014-01-10 |
| AMENDED ANNUAL REPORT | 2013-09-05 |
| ANNUAL REPORT | 2013-01-16 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-01-06 |
| ANNUAL REPORT | 2009-03-20 |
| ANNUAL REPORT | 2008-02-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
