| Entity Name: | IHS OF FLORIDA AT JACKSONVILLE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: | Inactive |
| Date Filed: | 05 Apr 1999 (26 years ago) |
| Date of dissolution: | 12 Jan 2016 (9 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 12 Jan 2016 (9 years ago) |
| Document Number: | F99000001772 |
| FEI/EIN Number | 52-2155335 |
| Address: | 1650 Fouraker Rd., Jacksonville, FL, 32221, US |
| Mail Address: | 1423 Clarkview Road, Suite 500, Baltimore, MD, 21209, US |
| ZIP code: | 32221 |
| County: | Duval |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033194279 | 2005-12-09 | 2014-07-16 | 1650 FOURAKER RD, JACKSONVILLE, FL, 32221, US | 1650 FOURAKER RD, JACKSONVILLE, FL, 32221, US | |||||||||||||||||||||||||
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| Phone | +1 904-786-8668 |
| Fax | 9046950166 |
Authorized person
| Name | MR. BRIAN REYNOLDS |
| Role | CEO |
| Phone | 4105138738 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1087096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 218171 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, TIMOTHY | Director | 1423 Clarkview Road, Baltimore, MD, 21209 |
| Name | Role | Address |
|---|---|---|
| POOLE, JOHN | President | 1423 Clarkview Road, Baltimore, MD, 21209 |
| Name | Role | Address |
|---|---|---|
| REYNOLDS BRIAN K | Othe | 1423 Clarkview Road, Baltimore, MD, 21209 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000067262 | WEST JACKSONVILLE HEALTH AND REHABILITATION CENTER | EXPIRED | 2011-07-05 | 2016-12-31 | No data | 7150 COLUMBIA GATEWAY DRIVE,, SUITE J, COLUMBIA, MD, 21046 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| WITHDRAWAL | 2016-01-12 | No data | No data |
| REGISTERED AGENT CHANGED | 2016-01-12 | REGISTERED AGENT REVOKED | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-20 | 1650 Fouraker Rd., Jacksonville, FL 32221 | No data |
| CHANGE OF MAILING ADDRESS | 2015-03-20 | 1650 Fouraker Rd., Jacksonville, FL 32221 | No data |
| Name | Date |
|---|---|
| Withdrawal | 2016-01-12 |
| AMENDED ANNUAL REPORT | 2015-03-20 |
| ANNUAL REPORT | 2015-03-12 |
| ANNUAL REPORT | 2014-04-18 |
| ANNUAL REPORT | 2013-04-12 |
| ANNUAL REPORT | 2012-04-05 |
| ANNUAL REPORT | 2011-01-05 |
| ANNUAL REPORT | 2010-01-11 |
| ANNUAL REPORT | 2009-02-05 |
| ANNUAL REPORT | 2008-04-30 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
