| Entity Name: | CRESTWOOD HOUSE,LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 12 Dec 2014 (10 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L14000190467 |
| FEI/EIN Number | 47-2640911 |
| Address: | 848 CRESTWOOD AVE, TITUSVILLE, FL, 32796 |
| Mail Address: | 848 CRESTWOOD AVE, TITUSVILLE, FL, 32796 |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144689852 | 2016-02-23 | 2016-02-23 | 848 CRESTWOOD AVE, TITUSVILLE, FL, 327962264, US | 848 CRESTWOOD AVE, TITUSVILLE, FL, 327962264, US | |||||||||||||||||||||||
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| Phone | +1 321-501-3280 |
Authorized person
| Name | DAVID ALAN MCKNIGHT |
| Role | MGMR |
| Phone | 3215013280 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL12735 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016035300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MCKNIGHT DAVID | Agent | 1170 OLD DIXIE HWY, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| MCKNIGHT DAVID | Manager | 1170 OLD DIXIE HWY, TITUSVILLE, FL, 32796 |
| Name | Role | Address |
|---|---|---|
| MCKNIGHT BRIDGETTE | Authorized Member | 1170 OLD DIXIE HWY, TITUSVILLE, FL, 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2021-04-19 |
| ANNUAL REPORT | 2020-04-30 |
| ANNUAL REPORT | 2019-02-12 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-04-21 |
| Florida Limited Liability | 2014-12-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
