| Entity Name: | GULF COAST HOLISTIC AND PRIMARY CARE INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 06 May 2013 (12 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P13000040250 |
| FEI/EIN Number | 46-2698118 |
| Address: | 219 FOREST PARK CIRCLE, PANAMA CITY, FL, 32405, US |
| Mail Address: | 219 FOREST PARK CIRCLE, PANAMA CITY, FL, 32405, US |
| ZIP code: | 32405 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205240363 | 2014-06-17 | 2014-06-17 | 756 HARRISON AVE, PANAMA CITY, FL, 324012524, US | 756 HARRISON AVE, PANAMA CITY, FL, 324012524, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-640-1530 |
| Fax | 8506401630 |
Authorized person
| Name | DR. RAQUEL SKIDMORE |
| Role | MEDICAL DIRECTOR |
| Phone | 8506401530 |
Taxonomy
| Taxonomy Code | 261QP2300X - Primary Care Clinic/Center |
| License Number | ACN244 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006732100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SKIDMORE RAQUEL Dr. | Agent | 219 FOREST PARK CIRCLE, PANAMA CITY, FL, 32405 |
| Name | Role | Address |
|---|---|---|
| SKIDMORE RAQUEL DR. | President | 219 FOREST PARK CIRCLE, PANAMA CITY, FL, 32405 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-05 | 219 FOREST PARK CIRCLE, PANAMA CITY, FL 32405 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-10-07 | 219 FOREST PARK CIRCLE, PANAMA CITY, FL 32405 | No data |
| CHANGE OF MAILING ADDRESS | 2016-10-07 | 219 FOREST PARK CIRCLE, PANAMA CITY, FL 32405 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-04-28 | SKIDMORE, RAQUEL, Dr. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-28 |
| Off/Dir Resignation | 2015-04-24 |
| ANNUAL REPORT | 2015-03-24 |
| ANNUAL REPORT | 2014-02-14 |
| Domestic Profit | 2013-05-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
