| Entity Name: | INDEPENDENCE - COMMUNITY ACCESS NETWORK, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 05 May 2006 (19 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 07 Sep 2010 (14 years ago) |
| Document Number: | P06000064043 |
| FEI/EIN Number | 204829875 |
| Address: | 1137 Lake Drive, Cocoa, FL, 32922, US |
| Mail Address: | 1137 Lake Drive, Cocoa, FL, 32922, US |
| ZIP code: | 32922 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033385919 | 2008-05-01 | 2016-12-29 | 600 FLORIDA AVE, SUITE 103, COCOA, FL, 329227953, US | 274 BREVARD AVE, COCOA, FL, 329227967, US | |||||||||||||||||||||||||||||||
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| Phone | +1 321-614-1379 |
| Phone | +1 321-745-2720 |
Authorized person
| Name | DR. JANICE M RENK-SCHREIBER |
| Role | CEO, CLINICAL DIRECTOR |
| Phone | 3218635286 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| License Number | 229742 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 685184396 |
| State | FL |
| Issuer | MEDICAID |
| Number | 685184398 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | Agent | 129 Valencia Rd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | President | 129 Valencia Rd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | Vice President | 129 Valencia Rd, Rockledge, FL, 32955 |
| Schreiber Robert | Vice President | 129 Valencia Rd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | Secretary | 129 Valencia Rd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | Treasurer | 129 Valencia Rd, Rockledge, FL, 32955 |
| Name | Role | Address |
|---|---|---|
| RENK-SCHREIBER JANICE | Director | 129 Valencia Rd, Rockledge, FL, 32955 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2023-01-24 | 1137 Lake Drive, Cocoa, FL 32922 | No data |
| CHANGE OF MAILING ADDRESS | 2023-01-24 | 1137 Lake Drive, Cocoa, FL 32922 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-26 | 129 Valencia Rd, Rockledge, FL 32955 | No data |
| AMENDMENT | 2010-09-07 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-24 |
| ANNUAL REPORT | 2022-02-10 |
| ANNUAL REPORT | 2021-01-15 |
| ANNUAL REPORT | 2020-02-20 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
