| Entity Name: | DELTONA ALF MANAGEMENT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Jan 2016 (9 years ago) |
| Document Number: | L16000004202 |
| FEI/EIN Number | 81-0991299 |
| Address: | 2310 N. NORMANDY BLVD, DELTONA, FL, 32725, US |
| Mail Address: | 269 KIPLING COURT, LAKE MARY, FL, 32746, US |
| ZIP code: | 32725 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023550498 | 2016-11-16 | 2017-12-20 | 2306 N. NORMANDY BLVD, DELTONA, FL, 32725, US | 2306 N NORMANDY BLVD, DELTONA, FL, 32725, US | |||||||||||||||||||||||||||||
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| Phone | +1 386-259-3860 |
| Fax | 3862593872 |
Authorized person
| Name | MR. DERICK WAYNE DEETER |
| Role | MANAGER |
| Phone | 4072020046 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | No |
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL13087 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022682200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DEETER DERICK | Agent | 269 KIPLING COURT, LAKE MARY, FL, 32746 |
| Name | Role | Address |
|---|---|---|
| DEETER DERICK | Manager | 269 KIPLING COURT, LAKE MARY, FL, 32746 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000007334 | GOLD CHOICE DELTONA | ACTIVE | 2016-01-20 | 2026-12-31 | No data | 269 KIPLING COURT, LAKE MARY, FL, 32746 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-02-27 | 2310 N. NORMANDY BLVD, DELTONA, FL 32725 | No data |
| CHANGE OF MAILING ADDRESS | 2018-02-27 | 2310 N. NORMANDY BLVD, DELTONA, FL 32725 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-20 |
| ANNUAL REPORT | 2022-05-02 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-01-07 |
| ANNUAL REPORT | 2019-03-02 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-06 |
| Florida Limited Liability | 2016-01-06 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
