| Entity Name: | VITALITY RESORT ALF, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 08 Nov 2013 (11 years ago) |
| Document Number: | L13000157216 |
| FEI/EIN Number | 46-5711850 |
| Address: | 1258 SW ERMINE AVE, PORT ST LUCIE, FL, 34953, US |
| Mail Address: | 11380 SW Hillcrest Cir, PORT ST LUCIE, FL, 34953, US |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033577978 | 2016-02-07 | 2016-02-07 | 1258 SW ERMINE AVE, PORT ST LUCIE, FL, 349535006, US | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 349872704, US | |||||||||||||||||||||||
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| Phone | +1 772-207-7947 |
Authorized person
| Name | MRS. CHRISTELLA DORVAL |
| Role | ADMINISTRATOR |
| Phone | 7722077947 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 12786 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012975500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DORVAL ANDRE J | Agent | 1258 ERMINE AVE, PORT ST LUCIE, FL, 34953 |
| Name | Role | Address |
|---|---|---|
| DORVAL ANDRE J | Managing Member | 1258 SW ERMINE AVE, PORT ST LUCIE, FL, 34953 |
| DORVAL CHRISTELLA A | Managing Member | 1258 SW ERMINE AVE, PORT ST LUCIE, FL, 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2015-04-26 | 1258 SW ERMINE AVE, PORT ST LUCIE, FL 34953 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-27 |
| ANNUAL REPORT | 2023-03-25 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-22 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-19 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
