| Entity Name: | BREAKWATER ADULT FAMILY CARE HOME LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 13 Feb 2003 (22 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | L03000005411 |
| FEI/EIN Number | 371458405 |
| Address: | 22699 SW BREAKWATER BLVD, DUNNELLON, FL, 34431 |
| Mail Address: | 22699 SW BREAKWATER BLVD, DUNNELLON, FL, 34431 |
| ZIP code: | 34431 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356407704 | 2006-12-29 | 2020-08-22 | 22699 SW BREAKWATER BLVD, DUNNELLON, FL, 344314039, US | 22699 SW BREAKWATER BLVD, DUNNELLON, FL, 344314039, US | |||||||||||||||||||
|
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| Phone | +1 352-401-7699 |
| Fax | 3524017698 |
Authorized person
| Name | VINCE JACOBS |
| Role | OWNER |
| Phone | 3525980288 |
Taxonomy
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| License Number | 6905655 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| JACOBS VINCE L | Agent | 22699 S.W. BREAKWATER BLVD, DUNNELLON, FL, 34431 |
| Name | Role | Address |
|---|---|---|
| JACOBS VINCE L | Chief Executive Officer | 22699 S.W. BREAKWATER BLVD, DUNNELLON, FL, 34431 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-08-23 | 22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431 | No data |
| CHANGE OF MAILING ADDRESS | 2004-08-23 | 22699 SW BREAKWATER BLVD, DUNNELLON, FL 34431 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-08-23 | 22699 S.W. BREAKWATER BLVD, DUNNELLON, FL 34431 | No data |
| NAME CHANGE AMENDMENT | 2003-09-03 | BREAKWATER ADULT FAMILY CARE HOME LLC | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13000056532 | LAPSED | 1000000446846 | MARION | 2012-12-26 | 2023-01-02 | $ 1,248.44 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE COLLECTIONS UNIT, 1401 W US HIGHWAY 90 STE 100, LAKE CITY FL320556123 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-02-09 |
| ANNUAL REPORT | 2009-04-06 |
| ANNUAL REPORT | 2008-04-16 |
| ANNUAL REPORT | 2007-07-31 |
| ANNUAL REPORT | 2006-04-22 |
| ANNUAL REPORT | 2005-04-02 |
| ANNUAL REPORT | 2004-08-23 |
| Name Change | 2003-09-03 |
| Florida Limited Liability | 2003-02-13 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
