| Entity Name: | FLORIDA ASSISTANT LIVING ORGANIZATION LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 16 Jul 2010 (15 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: | L10000075050 |
| FEI/EIN Number | 273081056 |
| Address: | 219 SE ABERNATHY WAY, MADISON, FL, 32340 |
| Mail Address: | 219 SE ABERNATHY WAY, MADISON, FL, 32340 |
| ZIP code: | 32340 |
| County: | Madison |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1194135525 | 2014-05-07 | 2014-05-07 | 458 NW MARION ST, MADISON, FL, 323401431, US | 219 SE ABERNATHY WAY, MADISON, FL, 323407044, US | |||||||||||||||||||||||||
|
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| Phone | +1 850-973-2348 |
| Phone | +1 850-973-2415 |
Authorized person
| Name | WILLIE M. PEACOCK |
| Role | ADMINISTRATOR |
| Phone | 8509732348 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 12141 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003217203 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEACOCK WILLIE | Agent | 219 SE ABERNATHY WAY, MADISON, FL, 32340 |
| Name | Role | Address |
|---|---|---|
| PEACOCK WILLIE | Managing Member | 219 SE ABERNATHY WAY, MADISON, FL, 32340 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000032810 | FLORIDA ASSISTANT LIVING ORGANIZATION HILL | EXPIRED | 2013-04-05 | 2018-12-31 | No data | 458 N.W. MARION ST, MADISON, FL, 32340 |
| G13000032811 | FLORIDA ASSISTANT LIVING ORGANIZATION CHATEAU | EXPIRED | 2013-04-05 | 2018-12-31 | No data | 240 S.E. STEPHEN ST, MADISON, FL, 32340 |
| G12000099401 | FLORIDA ASSISTANT LIVING ORGANIZATION LAKESHORE | EXPIRED | 2012-10-15 | 2017-12-31 | No data | 585 LAKESHORE DRIVE, MADISON, FL, 32340 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| LC DISSOCIATION MEM | 2016-05-24 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-04 | PEACOCK, WILLIE | No data |
| REINSTATEMENT | 2016-01-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 2014-12-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REINSTATEMENT | 2013-11-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| LC AMENDMENT | 2012-07-16 | No data | No data |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2016-05-24 |
| CORLCDSMEM | 2016-05-24 |
| REINSTATEMENT | 2016-01-04 |
| REINSTATEMENT | 2014-12-04 |
| Reinstatement | 2013-11-05 |
| LC Amendment | 2012-07-16 |
| Reinstatement | 2012-03-05 |
| Florida Limited Liability | 2010-07-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
