| Entity Name: | LOVELY CARE MANOR LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Jul 2012 (13 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: | L12000094331 |
| FEI/EIN Number | 46-0670801 |
| Address: | 2869 SARAH DRIVE, CLEARWATER, FL, 33759 |
| Mail Address: | 2869 SARAH DRIVE, CLEARWATER, FL, 33759 |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134550718 | 2013-12-06 | 2013-12-06 | 2869 SARAH DR, CLEARWATER, FL, 337592010, US | 2869 SARAH DR, CLEARWATER, FL, 337592010, US | |||||||||||||||||||||||
|
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| Phone | +1 727-754-5309 |
Authorized person
| Name | ANEE PHOUTHAVONG |
| Role | OWNER |
| Phone | 7277545309 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL12322 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008879500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PHOUTHAVONG ANEE | Agent | 8578 SOMERSET DRIVE, LARGO, FL, 33773 |
| Name | Role | Address |
|---|---|---|
| PHOUTHAVONG ANEE | Manager | 2869 SARAH DRIVE, CLEARWATER, FL, 33759 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-03-27 |
| ANNUAL REPORT | 2014-04-11 |
| ANNUAL REPORT | 2013-03-05 |
| Florida Limited Liability | 2012-07-18 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
