| Entity Name: | BETELGEUSE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Mar 2000 (25 years ago) |
| Document Number: | P00000024108 |
| FEI/EIN Number | 593636005 |
| Address: | 701 ENTRADA AVE, SEBRING, FL, 33875 |
| Mail Address: | 701 ENTRADA AVE, SEBRING, FL, 33875 |
| ZIP code: | 33875 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1497765671 | 2006-08-09 | 2010-12-01 | PO BOX 1586, SEBRING, FL, 338711586, US | 211 N FRANKLIN ST, SEBRING, FL, 338703124, US | |||||||||||||||||||||||||||||
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| Phone | +1 863-381-4276 |
Authorized person
| Name | MRS. LEAH RACHELLE PACE-AUBREY |
| Role | SPEECH LANGUGE PATHOLOGIST/OWNER |
| Phone | 8633814276 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA5105 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 889022600 |
| State | FL |
| Issuer | BCBS |
| Number | S2368 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PACE-AUBREY LEAH R | Agent | 701 ENTRADA AVE., SEBRING, FL, 33875 |
| Name | Role | Address |
|---|---|---|
| PACE-AUBREY LEAH R | President | 701 ENTRADA AVE., SEBRING, FL, 33875 |
| Name | Role | Address |
|---|---|---|
| PACE NANCIE A | Treasurer | 701 Entrada Ave, Sebring, FL, 33875 |
| Name | Role | Address |
|---|---|---|
| AUBREY Logan | Vice President | 701 ENTRADA AVE, SEBRING, FL, 33875 |
| Name | Role | Address |
|---|---|---|
| Bentley Merideth S | Secretary | PO Box 65, Hume, NY, 14745 |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
