| Entity Name: | HAMPTON ALF AT WEST, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 24 Sep 2010 (14 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | L10000099904 |
| FEI/EIN Number | 27-3542983 |
| Address: | 12980 SW HWY 484, DUNNELLON, FL 34432 |
| Mail Address: | 1805 SE 16TH AVE, SUITE 102, OCALA, FL 34471 |
| ZIP code: | 34432 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1073811774 | 2011-03-03 | 2011-03-03 | 12980 SE HWY 484, DUNNELLON, FL, 34432, US | 12980 SE 484, DUNNELLON, FL, 34432, US | |||||||||||||||||||||||||
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| Phone | +1 352-465-0300 |
| Fax | 3524657273 |
Authorized person
| Name | PAM CUTSURIES |
| Role | VP OF OPERATIONS |
| Phone | 3528045040 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7687 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001657800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSEN, PEDER | Agent | 1805 SE 16TH AVE, SUITE 102, OCALA, FL 34471 |
| Name | Role | Address |
|---|---|---|
| JOHNSEN, PEDER | Manager | 1805 SE 16TH AVE STE 102, OCALA, FL 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2012-04-27 | JOHNSEN, PEDER | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-28 | 12980 SW HWY 484, DUNNELLON, FL 34432 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2011-04-28 | 1805 SE 16TH AVE, SUITE 102, OCALA, FL 34471 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-29 |
| ANNUAL REPORT | 2012-04-27 |
| ANNUAL REPORT | 2011-04-28 |
| Florida Limited Liability | 2010-09-24 |
Date of last update: 24 Jan 2025
Sources: Florida Department of State
