| Entity Name: | GIBSON OF JAX, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 28 Aug 2006 (18 years ago) |
| Date of dissolution: | 27 Jul 2021 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Jul 2021 (4 years ago) |
| Document Number: | P06000111623 |
| FEI/EIN Number | 205451803 |
| Address: | 3775 CRICKET COVE ROAD EAST, JACKSONVILLE, FL, 32224, US |
| Mail Address: | 3775 CRICKET COVE ROAD EAST, JACKSONVILLE, FL, 32224, US |
| ZIP code: | 32224 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831422112 | 2009-09-17 | 2009-09-17 | 3775 CRICKET COVE RD E, JACKSONVILLE, FL, 322248401, US | 3775 CRICKET COVE RD E, JACKSONVILLE, FL, 322248401, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 904-254-0337 |
| Fax | 9042234368 |
Authorized person
| Name | MRS. KATHERINE WOODY GIBSON |
| Role | PRESIDENT |
| Phone | 9042540337 |
Taxonomy
| Taxonomy Code | 222Q00000X - Developmental Therapist |
| Is Primary | Yes |
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA 5525 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | INDIVIDUAL NPI |
| Number | 1356441828 |
| Issuer | MEDICAID |
| Number | 885295200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GIBSON KATHERINE W | Agent | 3775 CRICKET COVE ROAD EAST, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| GIBSON KATHERINE W | President | 3775 CRICKET COVE ROAD EAST, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| GIBSON THOMAS J | Vice President | 3775 CRICKET COVE ROAD EAST, JACKSONVILLE, FL, 32224 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2021-07-27 | No data | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2021-07-27 |
| ANNUAL REPORT | 2020-05-26 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-01-13 |
| ANNUAL REPORT | 2017-03-06 |
| ANNUAL REPORT | 2016-02-08 |
| ANNUAL REPORT | 2015-02-01 |
| ANNUAL REPORT | 2014-01-10 |
| ANNUAL REPORT | 2013-04-22 |
| ANNUAL REPORT | 2012-02-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
