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BOSWELL MANOR LLC

Company Details

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

National Provider Identifier

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

Contacts

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

Agent

Name Role Address
BOSWELL, LACEY Agent 2185 Highway 173, BONIFAY, FL 32425

President

Name Role Address
BOSWELL, LACEY President 2185 Highway 173, BONIFAY, FL 32425

Vice President

Name Role Address
BOSWELL, WILLIAM Vice President 2185 Highway 173, BONIFAY, FL 32425

Events

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

Documents

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