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LAKE PLACID REHABILITATION, INC.

Company Details

Entity Name: LAKE PLACID REHABILITATION, INC.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 30 Oct 2015 (9 years ago)
Document Number: P15000089566
FEI/EIN Number 47-5506447
Address: 1248 COUNTY RD. 29, LAKE PLACID, FL 33852
Mail Address: 1248 COUNTY RD. 29, LAKE PLACID, FL 33852
ZIP code: 33852
County: Highlands
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1811361512 2015-11-18 2016-03-29 145 TOWER ST, LAKE PLACID, FL, 338526836, US 145 TOWER ST, LAKE PLACID, FL, 338526836, US

Contacts

Phone +1 863-465-9991
Fax 8634659906

Authorized person

Name LINDA S CRUSE
Role OWNER
Phone 8634659991

Taxonomy

Taxonomy Code 208100000X - Physical Medicine & Rehabilitation Physician
License Number PT19782
State FL
Is Primary Yes

Other Provider Identifiers

Issuer FL BLUE
Number 88KKP
State FL

Agent

Name Role Address
CRUSE, LINDA Agent 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

President

Name Role Address
CRUSE, LINDA President 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

Secretary

Name Role Address
CRUSE, LINDA Secretary 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

Treasurer

Name Role Address
CRUSE, LINDA Treasurer 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

Director

Name Role Address
CRUSE, LINDA Director 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852
CRUSE, SHAWN Director 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

Vice President

Name Role Address
CRUSE, SHAWN Vice President 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852

Events

Event Type Filed Date Value Description
REGISTERED AGENT ADDRESS CHANGED 2019-04-12 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 No data
CHANGE OF PRINCIPAL ADDRESS 2018-10-22 1248 COUNTY RD. 29, LAKE PLACID, FL 33852 No data
CHANGE OF MAILING ADDRESS 2018-10-22 1248 COUNTY RD. 29, LAKE PLACID, FL 33852 No data

Documents

Name Date
ANNUAL REPORT 2024-04-23
ANNUAL REPORT 2023-04-12
ANNUAL REPORT 2022-04-17
ANNUAL REPORT 2021-04-27
ANNUAL REPORT 2020-06-30
ANNUAL REPORT 2019-04-12
ANNUAL REPORT 2018-04-04
ANNUAL REPORT 2017-04-12
ANNUAL REPORT 2016-04-28
Domestic Profit 2015-10-30

Date of last update: 20 Jan 2025

Sources: Florida Department of State