| Entity Name: | LAKE PSYCHOEDUCATIONAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 27 Jan 2006 (19 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P06000014100 |
| FEI/EIN Number | 204220282 |
| Address: | 600 N. HWY 27, SUITE # 1, MINNEOLA, FL, 34715 |
| Mail Address: | 316 BRIMMING LAKE RD, MINNEOLA, FL, 34715 |
| ZIP code: | 34715 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417341488 | 2015-03-26 | 2015-03-26 | 600 N HIGHWAY 27 STE 1, MINNEOLA, FL, 347156265, US | 600 N HIGHWAY 27 STE 1, MINNEOLA, FL, 347156265, US | |||||||||||||||||||||||||
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| Phone | +1 407-209-7492 |
| Fax | 3522418372 |
Authorized person
| Name | GRACE PENA |
| Role | PRESIDENT |
| Phone | 4072097492 |
Taxonomy
| Taxonomy Code | 101YM0800X - Mental Health Counselor |
| License Number | MH5773 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 762627400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PENA GRACE | Agent | 316 BRIMMING LAKE RD, MINNEOLA, FL, 34715 |
| Name | Role | Address |
|---|---|---|
| PENA GRACE | President | 316 BRIMMING LAKE RD, MINNEOLA, FL, 34715 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2010-01-07 | 600 N. HWY 27, SUITE # 1, MINNEOLA, FL 34715 | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-30 | 600 N. HWY 27, SUITE # 1, MINNEOLA, FL 34715 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-30 | 316 BRIMMING LAKE RD, MINNEOLA, FL 34715 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-12 |
| ANNUAL REPORT | 2013-01-14 |
| ANNUAL REPORT | 2012-01-19 |
| ANNUAL REPORT | 2011-01-11 |
| ANNUAL REPORT | 2010-01-07 |
| ANNUAL REPORT | 2009-04-30 |
| ANNUAL REPORT | 2008-03-23 |
| ANNUAL REPORT | 2007-04-15 |
| Domestic Profit | 2006-01-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
