| Entity Name: | CYPRESS HOME MEDICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 23 May 1997 (28 years ago) |
| Document Number: | P97000046782 |
| FEI/EIN Number | 650756463 |
| Address: | 11341 LINBERGH BLVD, FORT MYERS, FL, 33913 |
| Mail Address: | 485 HALF DAY RD, STE 300, BUFFALO GROVE, IL, 60089-8806, US |
| ZIP code: | 33913 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437188315 | 2006-07-02 | 2010-06-01 | 3911 PAYSPHERE CIR, CHICAGO, IL, 606740039, US | 11341 LINDBERGH BLVD, FORT MYERS, FL, 339138852, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 800-879-6137 |
| Fax | 8479139024 |
| Phone | +1 239-561-3456 |
| Fax | 2395614164 |
Authorized person
| Name | LORI ZSITEK |
| Role | VICE PRESIDENT AND ASST. SECRETARY |
| Phone | 8008796137 |
Taxonomy
| Taxonomy Code | 251E00000X - Home Health Agency |
| License Number | HHA20885096 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332B00000X - Durable Medical Equipment & Medical Supplies |
| License Number | PH0015307 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332BP3500X - Parenteral & Enteral Nutrition Supplies (DME) |
| License Number | PH0015307 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 332BX2000X - Oxygen Equipment & Supplies (DME) |
| License Number | PH0015307 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 3336H0001X - Home Infusion Therapy Pharmacy |
| License Number | PH0015307 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 106200001-01 (DME) |
| State | FL |
| Issuer | MEDICAID |
| Number | 106200000 (RX) |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| ZSITEK LORI | Vice President | 485 HALF DAY ROAD, BUFFALO GROVE, IL, 60089 |
| MANN JOHN | Vice President | 300 WILMOT ROAD, DEERFIELD, IL, 60015 |
| Name | Role | Address |
|---|---|---|
| ZSITEK LORI | Director | 485 HALF DAY ROAD, BUFFALO GROVE, IL, 60089 |
| Name | Role | Address |
|---|---|---|
| AZAR OREN | SECD | 104 WILMOT ROAD, DEERFIELD, IL, 60015 |
| Name | Role | Address |
|---|---|---|
| MASTRAPA PAUL | President | 485 HALF DAY ROAD, SUITE, BUFFALO GROVE, IL, 60089 |
| Name | Role | Address |
|---|---|---|
| KELLEN MARGARITA | Treasurer | 300 WILMOT RD, DEERFIELD, IL, 60015 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000016399 | WALGREENS INFUSION AND RESPIRATORY SERVICES | EXPIRED | 2010-02-19 | 2015-12-31 | No data | ATTN: LICENSING DEPARTMENT, 485 HALF DAY RD., SUITE 300, BUFFALO GROVE, IL, 60089 |
| G10000001238 | WALGREENS INFUSION SERVICES | EXPIRED | 2010-01-05 | 2015-12-31 | No data | LICENSING DEPARTMENT, 485 HALF DAY ROAD, SUITE 300, BUFFALO GROVE, IL, 60089 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2010-10-26 | No data | CORPORATION WAS PART OF A MERGER. NON-QUALIFIED CORPORATION WAS OPTION CARE ENTERPRISES, INC.. MERGER NUMBER 700000108467 |
| REINSTATEMENT | 1999-02-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1998-10-16 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
