| Entity Name: | WILLISTON HEALTH CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 16 Dec 2003 (21 years ago) |
| Date of dissolution: | 03 Aug 2009 (15 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 03 Aug 2009 (15 years ago) |
| Document Number: | P03000152312 |
| FEI/EIN Number | 20-0560531 |
| Address: | 451 SPANISH WELLS COURT, WINTER GARDEN, FL 34787 |
| Mail Address: | 451 SPANISH WELLS COURT, WINTER GARDEN, FL 34787 |
| ZIP code: | 34787 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811932015 | 2006-06-19 | 2020-08-22 | 300 NW 1ST AVE, WILLISTON, FL, 326962006, US | 300 NW 1ST AVE, WILLISTON, FL, 326962006, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-528-3561 |
Authorized person
| Name | STEVE STRAWN |
| Role | DIRECTOR |
| Phone | 6152172324 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1381096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | M71 |
| State | FL |
| Issuer | MEDICAID |
| Number | 02678300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BOYLES, WILLIAM A | Agent | 301 E. PINE STREET, SUITE 1400, ORLANDO, FL 32801 |
| Name | Role | Address |
|---|---|---|
| PARKER, SHELBY | Director | 4875 CASON COVE DR, ORLANDO, FL 32811 |
| STRAWN, STEVE | Director | 52 RILEY RD #301, CELEBRATION, FL 34747 |
| Name | Role | Address |
|---|---|---|
| PARKER, SHELBY | President | 4875 CASON COVE DR, ORLANDO, FL 32811 |
| Name | Role | Address |
|---|---|---|
| PARKER, SHELBY | Treasurer | 4875 CASON COVE DR, ORLANDO, FL 32811 |
| Name | Role | Address |
|---|---|---|
| AYERS, JACQUELYN | Secretary | P.O. BOX 11037, MURFREESBORO, TN 37129 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2009-08-03 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-03-30 | 451 SPANISH WELLS COURT, WINTER GARDEN, FL 34787 | No data |
| CHANGE OF MAILING ADDRESS | 2007-03-30 | 451 SPANISH WELLS COURT, WINTER GARDEN, FL 34787 | No data |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2009-08-03 |
| ANNUAL REPORT | 2008-03-25 |
| ANNUAL REPORT | 2007-03-30 |
| ANNUAL REPORT | 2006-01-30 |
| ANNUAL REPORT | 2005-04-13 |
| ANNUAL REPORT | 2004-07-23 |
| Domestic Profit | 2003-12-16 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
