| Entity Name: | THE IDA HOUSE ASSISTED LIVING LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 12 Jun 2017 (8 years ago) |
| Date of dissolution: | 15 Sep 2022 (2 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 15 Sep 2022 (2 years ago) |
| Document Number: | L17000127810 |
| FEI/EIN Number | 82-1881235 |
| Address: | 7908 Jackson Spring Rd, TAMPA, FL 33615 |
| Mail Address: | 7908 jackson springs rd, tampa, FL 33615 |
| ZIP code: | 33615 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083125132 | 2017-10-17 | 2019-03-06 | 6014 ROSEWOOD DR, TAMPA, FL, 336153428, US | 6014 ROSEWOOD DR, TAMPA, FL, 33615, US | |||||||||||||||||||||||
|
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| Phone | +1 813-562-6135 |
Authorized person
| Name | KIRENIA BACALLAO RUIZ |
| Role | PRESIDENT |
| Phone | 8135626135 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 13170 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 024909900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BACALLAO RUIZ, KIRENIA | Agent | 7908 Jackson Spring, TAMPA, FL 33615 |
| Name | Role | Address |
|---|---|---|
| Bacallao Ruiz, Kirenia | Manager | 7908 Jackson Spring Rd, TAMPA, FL 33615 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-09-15 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-03-30 | 7908 Jackson Spring Rd, TAMPA, FL 33615 | No data |
| CHANGE OF MAILING ADDRESS | 2022-03-30 | 7908 Jackson Spring Rd, TAMPA, FL 33615 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-30 | 7908 Jackson Spring, TAMPA, FL 33615 | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-12 | BACALLAO RUIZ, KIRENIA | No data |
| LC AMENDMENT | 2017-08-04 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J24000204105 | ACTIVE | 1000000984832 | HILLSBOROU | 2024-04-01 | 2034-04-10 | $ 517.50 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, TAMPA SERVICE CENTER, 5483 W WATERS AVE STE 1210, TAMPA FL336341236 |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-09-15 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-01-25 |
| ANNUAL REPORT | 2020-01-28 |
| ANNUAL REPORT | 2019-01-17 |
| ANNUAL REPORT | 2018-04-12 |
| LC Amendment | 2017-08-04 |
| Florida Limited Liability | 2017-06-12 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
