| Entity Name: | CATHERINE MANOR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 21 Mar 2003 (22 years ago) |
| Date of dissolution: | 27 Mar 2019 (6 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 27 Mar 2019 (6 years ago) |
| Document Number: | L03000010161 |
| FEI/EIN Number | 061694258 |
| Address: | 10591 BAY PINES BLVD., ST. PETERSBURG, FL, 33708 |
| Mail Address: | 10591 Bay Pines Blvd., ST. PETERSBURG, FL, 33708, US |
| ZIP code: | 33708 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568755064 | 2011-05-17 | 2011-05-17 | 10591 BAY PINES BLVD, ST PETERSBURG, FL, 337083101, US | 10591 BAY PINES BLVD, ST PETERSBURG, FL, 337083101, US | |||||||||||||||||||||||||
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| Phone | +1 727-391-5965 |
| Fax | 7273915965 |
Authorized person
| Name | MR. MICHAEL THOMAS GRADY |
| Role | MANAGING MEMBER |
| Phone | 7274883520 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7797 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142048800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ellingsworth Douglas | Agent | 175 Almedo Way NE, St. Petersburg, FL, 33704 |
| Name | Role | Address |
|---|---|---|
| ELLINGSWORTH DOUGLAS C | Manager | 10591 Bay Pines Blvd., ST. PETERSBURG, FL, 33708 |
| Name | Role | Address |
|---|---|---|
| GRADY THERESA M | Managing Member | 10591 Bay Pines Blvd., ST. PETERSBURG, FL, 33708 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000018883 | BAY PINES MANOR | EXPIRED | 2014-02-22 | 2019-12-31 | No data | 10591 BAY PINES BLVD., ST. PETERSBURG, FL, 33708 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2019-03-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2017-07-19 | Ellingsworth, Douglas | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-07-19 | 175 Almedo Way NE, St. Petersburg, FL 33704 | No data |
| CHANGE OF MAILING ADDRESS | 2013-04-26 | 10591 BAY PINES BLVD., ST. PETERSBURG, FL 33708 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-28 | 10591 BAY PINES BLVD., ST. PETERSBURG, FL 33708 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2019-03-27 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-07-19 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-21 |
| ANNUAL REPORT | 2014-04-29 |
| ANNUAL REPORT | 2013-04-26 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-04-18 |
| ANNUAL REPORT | 2010-04-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
