| Entity Name: | PURE RESTORATION ASSISTED LIVING OF CRYSTAL RIVER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 25 Sep 2017 (7 years ago) |
| Document Number: | L17000198081 |
| FEI/EIN Number | 82-2882563 |
| Mail Address: | 6239 EDGEWATER DRIVE, A1, ORLANDO, FL, 32810 |
| Address: | 125 NE 9TH AVE, CRYSTAL RIVER, FL, 34429 |
| ZIP code: | 34429 |
| County: | Citrus |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528562493 | 2018-03-23 | 2018-12-31 | 125 NE 9TH AVE, CRYSTAL RIVER, FL, 344294425, US | 125 NE 9TH AVE, CRYSTAL RIVER, FL, 344294425, US | |||||||||||||||||||
|
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| Phone | +1 321-750-6224 |
Authorized person
| Name | FRANCIA DAVID |
| Role | ADMINISTRATOR/OWNER |
| Phone | 3217506224 |
Taxonomy
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | ATN705105 |
| State | FL |
| Name | Role |
|---|---|
| 3-D FINANCIAL GROUP, LLC | Agent |
| Name | Role | Address |
|---|---|---|
| DAVID GREGORY | Chief Executive Officer | 6239 EDGEWATER DRIVE SUITE A1, ORLANDO, FL, 32810 |
| Name | Role | Address |
|---|---|---|
| DAVID FRANCIA | Chief Operating Officer | 6239 EDGEWATER DRIVE SUITE A1, ORLANDO, FL, 32810 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000106454 | PURE RESTORATION ASSISTED LIVING OF CRYSTAL RIVER | EXPIRED | 2017-09-26 | 2022-12-31 | No data | 125 NE 9TH AVENUE, CRYSTAL RIVER, FL, 34429 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-05-01 |
| ANNUAL REPORT | 2020-03-20 |
| ANNUAL REPORT | 2019-04-22 |
| ANNUAL REPORT | 2018-03-06 |
| Florida Limited Liability | 2017-09-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
