| Entity Name: | MERCY HOME ASSISTED LIVING FACILITY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Oct 2013 (11 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L13000148114 |
| FEI/EIN Number | 80-0792893 |
| Address: | 184 SE BEECH STREET, LAKE CITY, FL, 32025 |
| Mail Address: | 184 SE BEECH STREET, LAKE CITY, FL, 32025 |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1306249149 | 2014-10-08 | 2014-10-13 | 184 S.E. BEECH STREET, LAKE CITY, FL, 32025, US | 184 S.E. BEECH STREET, LAKE CITY, FL, 32025, US | |||||||||||||||||||||||||
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| Phone | +1 386-487-5029 |
| Fax | 3864875029 |
Authorized person
| Name | MRS. CLARA LEE FERGUSON |
| Role | ADMINISTRATOR/OWNER |
| Phone | 3864875029 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL12314 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009258500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERGUSON CLARA L | Agent | 184 SE BEECH STREET, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| FERGUSON CLARA L | Managing Member | 184 SE BEECH STREET, LAKE CITY, FL, 32025 |
| FERGUSON LEONARDO M | Managing Member | 222 SAILBOAT DRIVE, NASHVILLE, FL, 37217 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CONVERSION | 2013-10-22 | No data | CORPORATION WAS A CONVERSION RESULT. CONVERTING CORPORATION WAS P12000021490. CONVERSION NUMBER 900000135169 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-02-08 |
| ANNUAL REPORT | 2016-01-26 |
| ANNUAL REPORT | 2015-04-27 |
| ANNUAL REPORT | 2014-01-13 |
| Florida Limited Liability | 2013-10-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
