| Entity Name: | LAKE HEALTH CARE CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jul 1991 (34 years ago) |
| Document Number: | S66152 |
| FEI/EIN Number | 593081973 |
| Address: | 910 MT HOMER RD, EUSTIS, FL, 32726, US |
| Mail Address: | 910 MT HOMER RD, EUSTIS, FL, 32726, US |
| ZIP code: | 32726 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1104829316 | 2005-05-23 | 2010-06-22 | 910 MOUNT HOMER RD, EUSTIS, FL, 327266258, US | 910 MOUNT HOMER RD, EUSTIS, FL, 327266258, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 352-357-8615 |
Authorized person
| Name | LORRI J HARTLEY |
| Role | OFFICE ADMINISTRATOR |
| Phone | 3523578615 |
Taxonomy
| Taxonomy Code | 111N00000X - Chiropractor |
| License Number | NOTREQUIRED |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | NOTREQUIRED |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 213E00000X - Podiatrist |
| License Number | NOTREQUIRED |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| STONE GERKEN P | Agent | 4850 N. HWY 19A, MOUNT DORA, FL, 32757 |
| Name | Role | Address |
|---|---|---|
| FERNANDES JAMES S | President | 910 MT HOMER RD, EUSTIS, FL, 32726 |
| Name | Role | Address |
|---|---|---|
| FERNANDES JAMES S | Director | 910 MT HOMER RD, EUSTIS, FL, 32726 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 1995-06-30 | No data | No data |
| NAME CHANGE AMENDMENT | 1993-12-10 | LAKE HEALTH CARE CENTER, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
