| Entity Name: | WILLA CARSON HEALTH AND WELLNESS CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 29 Aug 1996 (28 years ago) |
| Document Number: | N96000004513 |
| FEI/EIN Number | 650743078 |
| Address: | 1108 N. MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Mail Address: | 1108 N. MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| ZIP code: | 33755 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902180789 | 2011-09-28 | 2011-09-28 | 1108 N MARTIN LUTHER KING JR AVE, CLEARWATER, FL, 337553222, US | 1108 N MARTIN LUTHER KING JR AVE, CLEARWATER, FL, 337553222, US | |||||||||||||||
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| Phone | +1 727-467-9411 |
| Fax | 7274672771 |
Authorized person
| Name | ANNIE TYRELL |
| Role | EXECUTIVE DIRECTOR |
| Phone | 7274679411 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| Nunn-Crawford Kimberley | Agent | 1108 N MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| Moore Felicia | Secretary | 1108 N. MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| Nunn-Crawford Kimberley | Othe | 1108 N MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| Heastie Ernestine C | Director | 1108 N. MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Sherman Thomas | Director | 1108 N. MARTIN LUTHER KING AVE, CLEARWATER, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| Childs Carlton | President | 1108 N. Martin L. King Jr. Ave., Clearwater, FL, 33755 |
| Name | Role | Address |
|---|---|---|
| Heastie Joe | Treasurer | 1108 N. Martin Luther King jr. Ave, clearwater, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2015-10-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| NAME CHANGE AMENDMENT | 2011-05-12 | WILLA CARSON HEALTH AND WELLNESS CENTER, INC. | No data |
| NAME CHANGE AMENDMENT | 2006-02-23 | WILLA CARSON HEALTH RESOURCE CENTER, INC. | No data |
| AMENDMENT | 1997-11-17 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
