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  5. JOHN KNOX VILLAGE OF TAMPA BAY, INC.

JOHN KNOX VILLAGE OF TAMPA BAY, INC. - Florida Company Profile

Headquarter

Company Details

Entity Name: JOHN KNOX VILLAGE OF TAMPA BAY, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Non-Profit
Status: Inactive

The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders.

Date Filed: 11 Sep 1979 (46 years ago)
Date of dissolution: 23 Sep 2022 (3 years ago)
Last Event: ADMIN DISSOLUTION FOR ANNUAL REPORT
Event Date Filed: 23 Sep 2022 (3 years ago)
Document Number: 748876
FEI/EIN Number 581377711

Federal Employer Identification (FEI) Number assigned by the IRS.
Address: 4100 E. FLETCHER AVENUE, TAMPA, FL, 33613, US
Mail Address: 4100 E. FLETCHER AVENUE, TAMPA, FL, 33613, US
ZIP code: 33613
County: Hillsborough
Place of Formation: FLORIDA

Links between entities

Type Company Name Company Number State
Headquarter of JOHN KNOX VILLAGE OF TAMPA BAY, INC., NEW YORK 626109 NEW YORK
Headquarter of JOHN KNOX VILLAGE OF TAMPA BAY, INC., NEW YORK 708173 NEW YORK

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1760479901 2005-10-03 2014-11-07 4100 E. FLETCHER AVE, TAMPA, FL, 336134863, US 4100 E. FLETCHER AVE, TAMPA, FL, 336134863, US

Contacts
Phone +1 813-632-2455
Fax 8136322388

Authorized person
Name MS. LISA VICARIO LYONS
Role EXECUTIVE DIRECTOR
Phone 8136322391

Taxonomy
Taxonomy Code 310400000X - Assisted Living Facility
License Number AL4110
State FL
Is Primary Yes
Taxonomy Code 314000000X - Skilled Nursing Facility
License Number SNF1260095
State FL
Is Primary No

Other Provider Identifiers
Issuer MEDICAID
Number 021028500
State FL
Issuer BLUECROSS BLUESHIELD
Number K68
State FL

Key Officers & Management

Name Role Address
GUY KIMBERLY Director 3001 W. DR. MARTIN LUTHER KING JR. BLVD., TAMPA, FL, 33607
Waters Glenn Director 2985 Drew Street, Clearwater, FL, 33759
Inzina Tommy Director 2985 Drew Street, Clearwater, FL, 33759
Polo Janice Director 2985 Drew Street, Clearwater, FL, 33759
BAYCARE HEALTH SYSTEM, INC. Agent -

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G13000111841 JOHN KNOX VILLAGE MED CENTER EXPIRED 2013-11-08 2018-12-31 - 4100 E FLETCHER AVE N, TAMPA, FL, 33613
G11000044429 ST. JOSEPH'S JOHN KNOX VILLAGE OF TAMPA BAY EXPIRED 2011-05-09 2016-12-31 - 3001 W. DR. MARTIN LUTHER KING BLVD, ATTENTION: ADMINISTRATION, TAMPA, FL, 33607, US

Events

Event Type Filed Date Value Description
ADMIN DISSOLUTION FOR ANNUAL REPORT 2022-09-23 - -
REGISTERED AGENT NAME CHANGED 2016-03-08 BAYCARE HEALTH SYSTEM, INC. -
REGISTERED AGENT ADDRESS CHANGED 2016-03-08 ATTENTION: LEGAL SERVICES DEPARTMENT, 2985 DREW STREET, CLEARWATER, FL 33759 -
AMENDED AND RESTATEDARTICLES 2014-07-02 - -
CHANGE OF PRINCIPAL ADDRESS 2014-04-02 4100 E. FLETCHER AVENUE, TAMPA, FL 33613 -
CHANGE OF MAILING ADDRESS 2014-04-02 4100 E. FLETCHER AVENUE, TAMPA, FL 33613 -
AMENDED AND RESTATEDARTICLES 1997-12-02 - -
AMENDMENT 1997-08-29 - -
AMENDED AND RESTATEDARTICLES 1991-01-30 - -

Documents

Name Date
ANNUAL REPORT 2021-03-02
ANNUAL REPORT 2020-02-03
ANNUAL REPORT 2019-02-12
ANNUAL REPORT 2018-04-16
ANNUAL REPORT 2017-04-24
ANNUAL REPORT 2016-03-08
ANNUAL REPORT 2015-04-27
Amended and Restated Articles 2014-07-02
ANNUAL REPORT 2014-04-02
AMENDED ANNUAL REPORT 2013-11-13

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
314912759 0420600 2010-08-27 4100 EAST FLETCHER AVE, TAMPA, FL, 33613
Inspection Type Complaint
Scope Partial
Safety/Health Health
Close Conference 2010-08-27
Emphasis N: NURSING
Case Closed 2010-08-27

Related Activity
Type Complaint
Activity Nr 208021220
Health Yes

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Inzina Tommy

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Polo Janice

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Companies related by address

No other companies in our directory share the same address as JOHN KNOX VILLAGE OF TAMPA BAY, INC.

Date of last update: 02 Apr 2025

Sources: Florida Department of State

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