| Entity Name: | AT HOME OF BREVARD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 19 Apr 2002 (23 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L02000009417 |
| FEI/EIN Number | 020584005 |
| Address: | 3116 Wendel Rd SE, PALM BAY, FL, 32909, US |
| Mail Address: | 3116 Wendel Rd SE, PALM BAY, FL, 32909, US |
| ZIP code: | 32909 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730314311 | 2009-05-26 | 2009-05-26 | 1351 DARROW RD SW, PALM BAY, FL, 329086248, US | 1351 DARROW RD SW, PALM BAY, FL, 329086248, US | |||||||||||||||||||||||||
|
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| Phone | +1 321-676-6331 |
| Fax | 3219512118 |
Authorized person
| Name | MICHAEL JOSEPH CULLEN |
| Role | ADMIINISTRATOR |
| Phone | 3216766331 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 9150 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 684950400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CULLEN Christine M | Agent | 3116 Wendel Rd SE, PALM BAY, FL, 32909 |
| Name | Role | Address |
|---|---|---|
| CULLEN CHRISTINE M | Manager | 3116 Wendel Rd SE, PALM BAY, FL, 32909 |
| THIBAULT AIMEE L | Manager | 3132 WENDEL RD SE, PALM BAY, FL, 32909 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000052291 | GOLDEN WINGS DARROW | EXPIRED | 2014-05-30 | 2019-12-31 | No data | 1351 DARROW RD SW, PALM BAY, FL, 32908 |
| G14000004312 | GOLDEN WINGS WENDEL | EXPIRED | 2014-01-13 | 2019-12-31 | No data | 3116 WENDEL RD SE, PALM BAY, FL, 32909 |
| G08042900421 | GOLDEN WINGS | EXPIRED | 2008-02-10 | 2013-12-31 | No data | 1351 DARROW RD SW, PALM BAY, FL, 32908 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-03-30 | 3116 Wendel Rd SE, PALM BAY, FL 32909 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-03-30 | 3116 Wendel Rd SE, PALM BAY, FL 32909 | No data |
| CHANGE OF MAILING ADDRESS | 2015-05-19 | 3116 Wendel Rd SE, PALM BAY, FL 32909 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-30 | CULLEN, Christine M | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000583799 | LAPSED | 14-472-D4 | LEON | 2018-05-22 | 2023-08-28 | $8,386.02 | DFS DIVISION OF WORKERS COMPENSATION, 200 EAST GAINES STREET, TALLAHASSEE, FL 32399-4228 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-03-30 |
| ANNUAL REPORT | 2015-05-19 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-03-25 |
| ANNUAL REPORT | 2011-03-31 |
| ANNUAL REPORT | 2010-02-16 |
| ANNUAL REPORT | 2009-06-15 |
| ANNUAL REPORT | 2008-12-12 |
| ANNUAL REPORT | 2008-01-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
