| Entity Name: | VERICARE OF FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 09 Oct 2000 (24 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | P00000095116 |
| FEI/EIN Number | 33-0931841 |
| Address: | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Mail Address: | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1609807239 | 2006-07-05 | 2017-07-11 | 55 HATCHETTS HILL RD, OLD LYME, CT, 063711534, US | 919 OLD WINTER HAVEN RD, AUBURNDALE, FL, 338234329, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 800-370-3651 |
| Fax | 8775157147 |
| Phone | +1 800-257-8715 |
| Fax | 8008191655 |
Authorized person
| Name | MELISSA KING |
| Role | DIRECTOR, CREDENTIALING ENROLLMENT |
| Phone | 8003703651 |
Taxonomy
| Taxonomy Code | 103TC0700X - Clinical Psychologist |
| Is Primary | Yes |
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | No |
| Taxonomy Code | 364SP0808X - Psychiatric/Mental Health Clinical Nurse Specialist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | CJ2290 |
| State | FL |
| Issuer | MEDICAID |
| Number | 011684500 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 38509 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Cooper, Thomas, MD | President | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Name | Role | Address |
|---|---|---|
| Cooper, Thomas, MD | Director | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Name | Role | Address |
|---|---|---|
| Lantier, Brian | Secretary | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Name | Role | Address |
|---|---|---|
| Lantier, Brian | Treasurer | 1480 Boston Post Road, Old Saybrook, CT 06475 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000093638 | MEDOPTIONS | EXPIRED | 2016-08-29 | 2021-12-31 | No data | 55 HATCHETTS HILL ROAD, OLD LYME, CT, 06371 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-14 | 1480 Boston Post Road, Old Saybrook, CT 06475 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-14 | 1480 Boston Post Road, Old Saybrook, CT 06475 | No data |
| REINSTATEMENT | 2018-02-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2015-10-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2012-05-17 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CANCEL ADM DISS/REV | 2007-10-08 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000229979 | ACTIVE | 1000000989075 | COLUMBIA | 2024-04-15 | 2044-04-17 | $ 990.00 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| J13000081696 | TERMINATED | 1000000280587 | LEON | 2012-12-17 | 2033-01-16 | $ 962.93 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2023-04-04 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-02-21 |
| ANNUAL REPORT | 2019-02-12 |
| REINSTATEMENT | 2018-02-12 |
| ANNUAL REPORT | 2016-02-26 |
| Reinstatement | 2015-10-14 |
| ANNUAL REPORT | 2013-04-16 |
| REINSTATEMENT | 2012-05-17 |
| ANNUAL REPORT | 2010-02-05 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
