| Entity Name: | HOLISTIC FAMILY HEALTH CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Sep 2002 (22 years ago) |
| Document Number: | P02000102731 |
| FEI/EIN Number | 270032179 |
| Address: | 6060 Oak St, Mims, FL, 32754, US |
| Mail Address: | PO BOX 259, SCOTTSMOOR, FL, 32775 |
| ZIP code: | 32754 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154503902 | 2007-12-04 | 2007-12-04 | PO BOX 259, SCOTTSMOOR, FL, 327750259, US | 3620 S HOPKINS AVE, SUITE 101, TITUSVILLE, FL, 327805707, US | |||||||||||||||||||||||
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| Phone | +1 321-385-1000 |
Authorized person
| Name | DEBORAH LEE |
| Role | DIRECTOR |
| Phone | 3213851000 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | AP1651 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUECROSS BLUESHIELD |
| Number | C0840 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEE DEBORAH A | Agent | 6060 OAK ST, Mims, FL, 32754 |
| Name | Role | Address |
|---|---|---|
| LEE DEBORAH A | President | PO BOX 259, SCOTTSMOOR, FL, 32775 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-20 | 6060 Oak St, Mims, FL 32754 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-15 | 6060 OAK ST, Mims, FL 32754 | No data |
| CHANGE OF MAILING ADDRESS | 2010-04-11 | 6060 Oak St, Mims, FL 32754 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-04-11 | LEE, DEBORAH A | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-16 |
| ANNUAL REPORT | 2021-04-18 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-04-11 |
| ANNUAL REPORT | 2018-04-21 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-08 |
| ANNUAL REPORT | 2015-04-03 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
