| Entity Name: | PETRIE GERIATRIC HEALTHCARE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 20 Apr 2009 (16 years ago) |
| Date of dissolution: | 06 Mar 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 06 Mar 2020 (5 years ago) |
| Document Number: | P09000035360 |
| FEI/EIN Number | 264687026 |
| Address: | 1286 FERNANDO CIRCLE, CANTONMENT, FL, 32533 |
| Mail Address: | 1286 FERNANDO CIRCLE, CANTONMENT, FL, 32533 |
| ZIP code: | 32533 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770727232 | 2009-04-28 | 2010-04-30 | P.O. BOX 37277, PENSACOLA, FL, 32526, US | 1286 FERNANDO CIR, CANTONMENT, FL, 325335737, US | |||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||
| Phone | +1 850-623-2948 |
| Phone | +1 850-516-1919 |
Authorized person
| Name | CLAIRE A PETRIE |
| Role | DIRECTOR |
| Phone | 8505161919 |
Taxonomy
| Taxonomy Code | 363LG0600X - Gerontology Nurse Practitioner |
| License Number | ARNP1222292 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 00A39 |
| State | FL |
| Issuer | MEDICAID |
| Number | 306540500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PETRIE CLAIRE A | Agent | 1286 FERNANDO CIRCLE, CANTONMENT, FL, 32533 |
| Name | Role | Address |
|---|---|---|
| PETRIE CLAIRE A | Director | 1286 FERNANDO CIRCLE, CANTONMENT, FL, 32533 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2020-03-06 | No data | No data |
| REINSTATEMENT | 2019-10-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-10-25 | PETRIE, CLAIRE A | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2020-03-06 |
| REINSTATEMENT | 2019-10-25 |
| ANNUAL REPORT | 2018-02-12 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-02-22 |
| ANNUAL REPORT | 2015-01-11 |
| ANNUAL REPORT | 2014-01-15 |
| ANNUAL REPORT | 2013-02-02 |
| ANNUAL REPORT | 2012-03-01 |
| ANNUAL REPORT | 2011-02-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
