| Entity Name: | CHOICES HEALTH CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Oct 2008 (16 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P08000094238 |
| FEI/EIN Number | 300509181 |
| Address: | 747 Fawn Ridge Drive, SUITE 100, ORANGE CITY, FL, 32763, US |
| Mail Address: | 747 Fawn Ridge Drive, SUITE 100, ORANGE CITY, FL, 32763, US |
| ZIP code: | 32763 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235369182 | 2009-07-24 | 2013-07-31 | 747 FAWN RIDGE DR, SUITE 100, ORANGE CITY, FL, 327638268, US | 747 FAWN RIDGE DR, SUITE 100, ORANGE CITY, FL, 327638268, US | |||||||||||||||||||||||||
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| Phone | +1 386-456-1047 |
| Fax | 8667073476 |
Authorized person
| Name | MR. SHANE E WILSON |
| Role | COO |
| Phone | 3864561047 |
Taxonomy
| Taxonomy Code | 261Q00000X - Clinic/Center |
| License Number | HCC7157 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004619500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WILSON SHANE E | Agent | 603 FIORELLA COURT, DEBARY, FL, 32713 |
| Name | Role | Address |
|---|---|---|
| SHULMAN CARLA SARNP | Manager | 747 Fawn Ridge Drive, ORANGE CITY, FL, 32763 |
| Name | Role | Address |
|---|---|---|
| WILSON Shane E | Chief Operating Officer | 747 Fawn Ridge Drive, ORANGE CITY, FL, 32763 |
| Name | Role | Address |
|---|---|---|
| LOSS MICHAEL RDr. | Medi | 747 Fawn Ridge Drive, ORANGE CITY, FL, 32763 |
| Name | Role | Address |
|---|---|---|
| WILSON SHANE EARNP | Vice President | 603 FIORELLA CT., DEBARY, FL, 32713 |
| Name | Role | Address |
|---|---|---|
| WILSON SHANE EARNP | Secretary | 603 FIORELLA CT., DEBARY, FL, 32713 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| AMENDMENT | 2013-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-01-28 | 747 Fawn Ridge Drive, SUITE 100, ORANGE CITY, FL 32763 | No data |
| CHANGE OF MAILING ADDRESS | 2013-01-28 | 747 Fawn Ridge Drive, SUITE 100, ORANGE CITY, FL 32763 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-01-12 | WILSON, SHANE E | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-01-06 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-28 |
| ANNUAL REPORT | 2014-01-10 |
| Amendment | 2013-09-23 |
| AMENDED ANNUAL REPORT | 2013-07-31 |
| ANNUAL REPORT | 2013-01-28 |
| ANNUAL REPORT | 2012-01-09 |
| ANNUAL REPORT | 2011-01-12 |
| ANNUAL REPORT | 2010-04-05 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
