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 |
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 | |||||||||||||||||||||||||
|
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 |
Name | Role | Address |
---|---|---|
CRUSE, LINDA | Agent | 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 |
Name | Role | Address |
---|---|---|
CRUSE, LINDA | President | 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 |
Name | Role | Address |
---|---|---|
CRUSE, LINDA | Secretary | 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 |
Name | Role | Address |
---|---|---|
CRUSE, LINDA | Treasurer | 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 |
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 |
Name | Role | Address |
---|---|---|
CRUSE, SHAWN | Vice President | 1248 COUNTY ROAD 29, LAKE PLACID, FL 33852 |
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 |
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