Entity Name: | BOSWELL MANOR LLC |
Jurisdiction: | FLORIDA |
Filing Type: | Florida Limited Liability Company |
Status: | Active |
Date Filed: | 14 Sep 2016 (8 years ago) |
Last Event: | LC AMENDMENT |
Event Date Filed: | 30 Sep 2016 (8 years ago) |
Document Number: | L16000171506 |
FEI/EIN Number | 81-3957024 |
Address: | 2185 HWY 173, BONIFAY, FL 32425 |
Mail Address: | 2185 HWY 173, BONIFAY, FL 32425 |
ZIP code: | 32425 |
County: | Holmes |
Place of Formation: | FLORIDA |
NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1013489962 | 2018-12-17 | 2018-12-17 | 2185 HIGHWAY 173, BONIFAY, FL, 324255705, US | 2185 HIGHWAY 173, BONIFAY, FL, 324255705, US | |||||||||||||||||||
|
Phone | +1 850-768-9026 |
Authorized person
Name | MRS. LACEY BOSWELL |
Role | OWNER/ADMINISTRATOR |
Phone | 8507689026 |
Taxonomy
Taxonomy Code | 310400000X - Assisted Living Facility |
Is Primary | Yes |
Other Provider Identifiers
Issuer | MEDICAID |
Number | 100834700 |
State | FL |
Name | Role | Address |
---|---|---|
BOSWELL, LACEY | Agent | 2185 Highway 173, BONIFAY, FL 32425 |
Name | Role | Address |
---|---|---|
BOSWELL, LACEY | President | 2185 Highway 173, BONIFAY, FL 32425 |
Name | Role | Address |
---|---|---|
BOSWELL, WILLIAM | Vice President | 2185 Highway 173, BONIFAY, FL 32425 |
Event Type | Filed Date | Value | Description |
---|---|---|---|
REGISTERED AGENT ADDRESS CHANGED | 2018-04-30 | 2185 Highway 173, BONIFAY, FL 32425 | No data |
CHANGE OF PRINCIPAL ADDRESS | 2017-10-30 | 2185 HWY 173, BONIFAY, FL 32425 | No data |
CHANGE OF MAILING ADDRESS | 2017-10-30 | 2185 HWY 173, BONIFAY, FL 32425 | No data |
LC AMENDMENT | 2016-09-30 | No data | No data |
Name | Date |
---|---|
ANNUAL REPORT | 2024-03-06 |
ANNUAL REPORT | 2023-04-12 |
ANNUAL REPORT | 2022-04-05 |
ANNUAL REPORT | 2021-02-11 |
ANNUAL REPORT | 2020-04-28 |
ANNUAL REPORT | 2019-05-13 |
ANNUAL REPORT | 2018-04-30 |
ANNUAL REPORT | 2017-04-26 |
LC Amendment | 2016-09-30 |
Florida Limited Liability | 2016-09-14 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State