| Entity Name: | VITALITY STAR RESORT ALF LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 Mar 2017 (8 years ago) |
| Document Number: | L17000073415 |
| FEI/EIN Number | 82-1017846 |
| Mail Address: | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 34987 |
| Address: | 591 SW BRADSHAW CIR, PORT SAINT LUCIE, FL, 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1760958847 | 2018-10-16 | 2018-10-16 | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 349872704, US | 591 SW BRADSHAW CIR, PORT ST LUCIE, FL, 349535539, US | |||||||||||||||||||||
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| Phone | +1 772-539-0405 |
| Phone | +1 772-207-7947 |
Authorized person
| Name | MRS. CHRISTELLA DORVAL |
| Role | ADMINISTRATOR |
| Phone | 7722077947 |
Taxonomy
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 023404800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DORVAL CHRISTELLA A | Agent | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 34987 |
| Name | Role | Address |
|---|---|---|
| DORVAL CHRISTELLA | Manager | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 34987 |
| DORVAL ANDRE A | Manager | 11380 SW HILLCREST CIR, PORT ST LUCIE, FL, 34987 |
| Name | Role | Address |
|---|---|---|
| Dorval Andre J | Member | 11380 SW Hillcrest Cir, Port St Lucie, FL, 34987 |
| Dorval Christella A | Member | 11380 SW Hillcrest Cir, Port St Lucie, FL, 34987 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2025-01-15 | DORVAL, Andre J | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-15 |
| ANNUAL REPORT | 2024-01-27 |
| AMENDED ANNUAL REPORT | 2023-04-02 |
| ANNUAL REPORT | 2023-03-25 |
| ANNUAL REPORT | 2022-04-08 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-06-08 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-22 |
| Florida Limited Liability | 2017-03-31 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
