| Entity Name: | CAPE MEMORIAL HOSPITAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 16 May 1996 (29 years ago) |
| Document Number: | N96000002633 |
| FEI/EIN Number | 650666516 |
| Address: | 636 DEL PRADO BLVD, CAPE CORAL, FL, 33990, US |
| Mail Address: | 2776 CLEVELAND AVENUE, LEGAL DEPT MOC 459, FORT MYERS, FL, 33901, US |
| ZIP code: | 33990 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487760906 | 2006-08-21 | 2014-12-19 | PO BOX 150107, CAPE CORAL, FL, 339150107, US | 636 DEL PRADO BLVD, CAPE CORAL, FL, 339902695, US | |||||||||||||||||||||||||||||||
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| Phone | +1 239-242-6012 |
| Fax | 2394241599 |
| Phone | +1 239-424-1503 |
Authorized person
| Name | BENJAMIN SPENCE |
| Role | CHEIF FINANCIAL OFFICER |
| Phone | 2393436012 |
Taxonomy
| Taxonomy Code | 282N00000X - General Acute Care Hospital |
| License Number | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS PROVIDER NUMBE |
| Number | 575 |
| State | FL |
| Issuer | MEDICAID |
| Number | 011971700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCGILLICUDDY MARY A | Agent | 4211 METRO PKWY, FORT MYERS, FL, 33916 |
| Name | Role | Address |
|---|---|---|
| COLLINS DAVID | Treasurer | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| KLEIN DAVID | Vice Chairman | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| CLARKE DONNA | Chairman | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| ALLEN DANE | Secretary | 2776 CLEVELAND AVENUE, FORT MYERS, FL, 33901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G18000079005 | CAPE CORAL HOSPITAL | ACTIVE | 2018-07-23 | 2028-12-31 | No data | 636 DEL PRADO BOULEVARD, CAPE CORAL, FL, 33990 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2024-10-30 | No data | No data |
| CANCEL ADM DISS/REV | 2009-04-08 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2008-09-26 | No data | No data |
| AMENDMENT | 2002-04-15 | No data | No data |
| AMENDMENT | 1996-07-19 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
