| Entity Name: | SANDLAKE FAMILY CARE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 May 2003 (22 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P03000061583 |
| FEI/EIN Number | 861064309 |
| Address: | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL, 32819 |
| Mail Address: | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL, 32819 |
| ZIP code: | 32819 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1881882991 | 2007-10-15 | 2010-08-06 | PO BOX 690871, ORLANDO, FL, 328690871, US | 7364 STONEROCK CIR, STE B, ORLANDO, FL, 328198000, US | |||||||||||||||||||||||||||
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| Phone | +1 407-352-8188 |
| Fax | 4073519057 |
Authorized person
| Name | DR. GHYEATH AYOUBI |
| Role | PRESIDENT |
| Phone | 4073528188 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CORPORATION |
| Number | K4707 |
| State | FL |
| Issuer | MEDICAID |
| Number | 377305101 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AYOUBI GHYEATH | Agent | 7364 STONE ROCK CIR, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| AYOUBI GHYEATH | Director | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL, 32819 |
| Name | Role | Address |
|---|---|---|
| AYOUBI GHYEATH | President | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL, 32819 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-01-16 | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL 32819 | No data |
| CHANGE OF MAILING ADDRESS | 2005-01-16 | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL 32819 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-01-16 | 7364 STONE ROCK CIR, SUITE # B, ORLANDO, FL 32819 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-02-26 |
| ANNUAL REPORT | 2018-03-05 |
| ANNUAL REPORT | 2017-02-20 |
| ANNUAL REPORT | 2016-02-08 |
| ANNUAL REPORT | 2015-02-23 |
| ANNUAL REPORT | 2014-02-04 |
| ANNUAL REPORT | 2013-03-11 |
| ANNUAL REPORT | 2012-01-30 |
| ANNUAL REPORT | 2011-02-07 |
| ANNUAL REPORT | 2010-04-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
