| Entity Name: | EISENHOWER JACKSONVILLE GROUP, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 23 Nov 2015 (9 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 09 Dec 2016 (8 years ago) |
| Document Number: | L15000197972 |
| FEI/EIN Number | 81-0979341 |
| Address: | 2671 Huffman Blvd., Jacksonville, FL 32246 |
| Mail Address: | 3200 EAST EISENHOWER PARKWAY, ANN ARBOR, MI 48108 |
| ZIP code: | 32246 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417494485 | 2017-01-27 | 2021-09-28 | 2671 HUFFMAN BLVD, JACKSONVILLE, FL, 322464056, US | 2671 HUFFMAN BLVD, JACKSONVILLE, FL, 322464056, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 734-677-0070 |
| Fax | 7346770890 |
Authorized person
| Name | MR. ANN PENDLEY |
| Role | PRESIDENT |
| Phone | 7346770070 |
Taxonomy
| Taxonomy Code | 2081P0301X - Brain Injury Medicine (Physical Medicine & Rehabilitation) Physician |
| Is Primary | No |
| Taxonomy Code | 251B00000X - Case Management Agency |
| Is Primary | No |
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QM0801X - Mental Health Clinic/Center (Including Community Mental Health Center) |
| Is Primary | Yes |
| Taxonomy Code | 320600000X - Intellectual and/or Developmental Disabilities Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 320700000X - Physical Disabilities Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 320800000X - Mental Illness Community Based Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 320900000X - Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 323P00000X - Psychiatric Residential Treatment Facility |
| Is Primary | No |
Other Provider Identifiers
| Issuer | TRANSITIONAL LIVING FACILITY |
| Number | 1558544130 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Ingram, Matthew | Agent | 2671 Huffman Blvd, Jacksonville, FL 32246 |
| Name | Role | Address |
|---|---|---|
| MORIAH INCORPORATED | Manager | 3200 EAST EISENHOWER PARKWAY, ANN ARBOR, MI 48108 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2017-02-17 | 2671 Huffman Blvd., Jacksonville, FL 32246 | No data |
| REINSTATEMENT | 2016-12-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-12-09 | Ingram, Matthew | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-12-09 | 2671 Huffman Blvd, Jacksonville, FL 32246 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-05 |
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-07-13 |
| AMENDED ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2022-03-07 |
| ANNUAL REPORT | 2021-03-12 |
| ANNUAL REPORT | 2020-06-05 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-04-09 |
| AMENDED ANNUAL REPORT | 2017-03-14 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
