| Entity Name: | PHC - BLOUNTSTOWN, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 01 Aug 2000 (25 years ago) |
| Date of dissolution: | 16 Mar 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 16 Mar 2015 (10 years ago) |
| Document Number: | P00000074441 |
| FEI/EIN Number | 593670300 |
| Address: | 909 GARDENGATE CIR., PENSACOLA, FL, 32504 |
| Mail Address: | 909 GARDENGATE CIRCLE, PENSACOLA, FL, 32504 |
| ZIP code: | 32504 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972594729 | 2005-11-01 | 2008-06-17 | 909 GARDEN GATE CIR, PENSACOLA, FL, 325048629, US | 17884 NE CROZIER ST, BLOUNTSTOWN, FL, 324241050, US | |||||||||||||||||||||||||||||
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| Phone | +1 850-682-5322 |
| Fax | 8506892510 |
| Phone | +1 850-674-5464 |
| Fax | 8506749384 |
Authorized person
| Name | MRS. CATHERINE A ATES |
| Role | PRESIDENT, CHIEF OPERATING OFFICER |
| Phone | 8506825322 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF12870961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025109700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOFFMAN LINDA A | Agent | 801 W. ROMANANA STREET, PENSACOLA, FL, 32502 |
| Name | Role | Address |
|---|---|---|
| ATES CATHERINE A | President | 909 GARDENGATE CIRLCE, PENSACOLA, FL, 32504 |
| Name | Role | Address |
|---|---|---|
| ELLIS GREGORY A | Secretary | 909 GARDENGATE CIRCLE, PENSACOLA, FL, 32504 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-03-16 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-12-30 | 909 GARDENGATE CIR., PENSACOLA, FL 32504 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2010-09-15 | 801 W. ROMANANA STREET, SUITE A, PENSACOLA, FL 32502 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2015-03-16 |
| ANNUAL REPORT | 2014-02-24 |
| ANNUAL REPORT | 2013-03-20 |
| ANNUAL REPORT | 2012-01-19 |
| ANNUAL REPORT | 2011-02-09 |
| AC | 2010-12-30 |
| Reg. Agent Change | 2010-09-15 |
| ANNUAL REPORT | 2010-01-19 |
| ANNUAL REPORT | 2009-01-29 |
| ANNUAL REPORT | 2008-01-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
