| Entity Name: | THE FANNIE E. TAYLOR HOME FOR THE AGED-CARE CENTER, INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 09 Aug 1982 (42 years ago) |
| Document Number: | 764469 |
| FEI/EIN Number | 592307493 |
| Mail Address: | 6601 CHESTER AVENUE, JACKSONVILLE, FL, 32217, US |
| Address: | 6535 CHESTER AVE., JACKSONVILLE, FL, 32217, US |
| ZIP code: | 32217 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033257886 | 2007-02-02 | 2012-04-11 | 6535 CHESTER AVE, JACKSONVILLE, FL, 322172250, US | 6535 CHESTER AVE, JACKSONVILLE, FL, 322172250, US | |||||||||||||||||||||||||
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| Phone | +1 904-731-8230 |
| Fax | 9047310669 |
Authorized person
| Name | HANNA RADCLIFFE |
| Role | ADMINISTRATOR |
| Phone | 9047318230 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1554096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 020744600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Hoeckelberg Deborah | Agent | 6601 CHESTER AVENUE, JACKSONVILLE, FL, 32217 |
| Name | Role | Address |
|---|---|---|
| HOECKELBERG DEBORAH | Secretary | 4950 MOTOR YACHT DRIVE, JACKSONVILLE, FL, 32225 |
| Name | Role | Address |
|---|---|---|
| BARBER JOHN WJR | President | 2900 State Road 13, Jacksonville, FL, 32259 |
| Name | Role | Address |
|---|---|---|
| Hill Carol | Vice President | 10834 Wahine Dr N, Jacksonville, FL, 32246 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000047641 | TAYLOR RESIDENCES | ACTIVE | 2022-04-14 | 2027-12-31 | No data | 6601 CHESTER AVENUE, JACKSONVILLE, FL, 32217 |
| G19000053922 | TAYLOR CARE CENTER | ACTIVE | 2019-05-02 | 2029-12-31 | No data | 6601 CHESTER AVENUE, JACKSONVILLE, FL, 32217 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2021-08-26 | THE FANNIE E. TAYLOR HOME FOR THE AGED-CARE CENTER, INC | No data |
| AMENDMENT AND NAME CHANGE | 2017-10-16 | FANNIE E. TAYLOR HOME FOR THE AGED-CARE CENTER, INC. | No data |
| AMENDMENT | 2010-10-01 | No data | No data |
| AMENDMENT | 2001-02-06 | No data | No data |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
