| Entity Name: | SPACE COAST HEALTH CARE SERVICES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Apr 2002 (23 years ago) |
| Document Number: | P02000042262 |
| FEI/EIN Number | 030441976 |
| Address: | 2080 W EAU GALLIE BLVD, MELBOURNE, FL, 32935 |
| Mail Address: | 2080 W EAU GALLIE BLVD, MELBOURNE, FL, 32935 |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144274358 | 2006-05-20 | 2020-08-22 | 2080 W EAU GALLIE BLVD, SUITE A, MELBOURNE, FL, 329353185, US | 2080 W EAU GALLIE BLVD, SUITE A, MELBOURNE, FL, 329353185, US | |||||||||||||||
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| Phone | +1 321-254-6218 |
| Fax | 3212546230 |
Authorized person
| Name | DR. MICHAEL ALAN SHAPIRO |
| Role | CHIEF EXECUTIVE OFFICER |
| Phone | 3212546218 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KANCILIA JOHN R | Agent | 1795 WEST NASA BLVD, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| MEHINDRU VINAY M | President | 2080 W EAU GALLIE BLVD, SUITE A, MELBOURNE, FL, 32935 |
| Name | Role | Address |
|---|---|---|
| SHAPIRO MICHAEL A | Chief Financial Officer | 2080 W EAU GALLIE BLVD, SUITE A, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2009-01-30 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
