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IDA WALLACE BENNETT FAMILY HEALTH, CORPORATION. - Florida Company Profile

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Company Details

Entity Name: IDA WALLACE BENNETT FAMILY HEALTH, CORPORATION.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 07 Sep 2006 (19 years ago)
Document Number: P06000115836
FEI/EIN Number 651291931
Address: 5944 E COPPS HWY, LAMONT, FL, 32336
Mail Address: 742 Olympic Circle, Ocoee, FL, 34761, US
ZIP code: 32336
City: Lamont
County: Jefferson
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
JOHNSON PAMELA V President 331 N DEERFIELD AVENUE, DEERFIELD BEACH, FL, 33441
JOHNSON PAMELA V Agent 742 Olympic Circle, Ocoee, FL, 34761

Unique Entity ID

CAGE Code:
4LT26
UEI Expiration Date:
2016-01-02

Business Information

Activation Date:
2015-01-06
Initial Registration Date:
2006-12-01

Commercial and government entity program

CAGE number:
4LT26
Status:
Active
Type:
Non-Manufacturer
CAGE Update Date:
2016-01-02

Contact Information

POC:
PAMELA V. JOHNSON

National Provider Identifier

NPI Number:
1417085697

Authorized Person:

Name:
PAMELA V JOHNSON
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
261QH0100X - Health Service Clinic/Center
Is Primary:
No
Selected Taxonomy:
363L00000X - Nurse Practitioner
Is Primary:
Yes

Contacts:

Fax:
9544221726

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G12000101588 CONSULTIDANP EXPIRED 2012-10-17 2017-12-31 - POST OFFICE BOX 783, DEERFIELD BEACH, FL, 33441

Events

Event Type Filed Date Value Description
CHANGE OF MAILING ADDRESS 2024-03-27 5944 E COPPS HWY, LAMONT, FL 32336 -
REGISTERED AGENT ADDRESS CHANGED 2024-03-27 742 Olympic Circle, Ocoee, FL 34761 -
CHANGE OF PRINCIPAL ADDRESS 2007-03-23 5944 E COPPS HWY, LAMONT, FL 32336 -

Documents

Name Date
ANNUAL REPORT 2025-01-22
ANNUAL REPORT 2024-03-27
ANNUAL REPORT 2023-03-02
ANNUAL REPORT 2022-03-06
ANNUAL REPORT 2021-03-17
ANNUAL REPORT 2020-03-22
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-02-26
ANNUAL REPORT 2017-01-29
ANNUAL REPORT 2016-03-27

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Date of last update: 02 Aug 2025

Sources: Florida Department of State