| Entity Name: | RESTHAVEN OF HARDEE COUNTY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 01 Jul 1983 (42 years ago) |
| Document Number: | 769202 |
| FEI/EIN Number | 591471892 |
| Address: | 298 RESTHAVEN BLVD, ZOLFO SPRINGS, FL, 33890 |
| Mail Address: | 298 Resthaven Road, Zolfo Springs, FL, 33890, US |
| ZIP code: | 33890 |
| County: | Hardee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1700020914 | 2009-05-01 | 2009-05-01 | 120 N 4TH AVE, WAUCHULA, FL, 338732710, US | 298 RESTHAVEN RD, ZOLFO SPRINGS, FL, 338909500, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 863-773-2637 |
| Phone | +1 863-773-6000 |
Authorized person
| Name | MARY LOIS CRAWLEY |
| Role | CHAIRMAN BOARD OF DIRECTORS |
| Phone | 8637736000 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL5073 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142410600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Storts Danielle | Agent | 120 W Orange Street, WAUCHULA, FL, 33873 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JACKI | President | 1045 W. County Line Road, BOWLING GREEN, FL, 33834 |
| Name | Role | Address |
|---|---|---|
| JOHNSON JACKI | Director | 1045 W. County Line Road, BOWLING GREEN, FL, 33834 |
| GOURLEY WAYNE | Director | 3160 MURPHY ROAD, ONA, FL, 33865 |
| DURRANCE DIANA | Director | 3635 W. Main Street, Wauchula, FL, 33873 |
| Name | Role | Address |
|---|---|---|
| GOURLEY WAYNE | Vice President | 3160 MURPHY ROAD, ONA, FL, 33865 |
| Name | Role | Address |
|---|---|---|
| DURRANCE DIANA | Treasurer | 3635 W. Main Street, Wauchula, FL, 33873 |
| Name | Role | Address |
|---|---|---|
| Clark Linda | dire | 298 RESTHAVEN BLVD, ZOLFO SPRINGS, FL, 33890 |
| Prestwood Luna | dire | 298 RESTHAVEN BLVD, ZOLFO SPRINGS, FL, 33890 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-01-23 | No data | No data |
| AMENDMENT | 1985-01-17 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
