| Entity Name: | RESIDENTIAL PLAZA AT BLUE LAGOON, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 22 Sep 1989 (35 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 27 Aug 2015 (9 years ago) |
| Document Number: | L18542 |
| FEI/EIN Number | 65-0149987 |
| Address: | 5617 NW 7TH STREET, MIAMI, FL 33126 |
| Mail Address: | 5617 NW 7TH STREET, MIAMI, FL 33126 |
| ZIP code: | 33126 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548546559 | 2011-10-24 | 2011-10-24 | 5617 NW 7TH ST, MIAMI, FL, 331263216, US | 5617 NW 7TH ST, MIAMI, FL, 331263216, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-267-2700 |
| Fax | 3052672708 |
Authorized person
| Name | BARBARA GALINDO |
| Role | ADMINISTRATOR |
| Phone | 3052672700 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7551 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140772400 |
| State | FL |
| Issuer | MEDICAID |
| Number | 676874100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Mino, Isolina | Agent | 5617 NW 7 STREET, MIAMI, FL 33126 |
| Name | Role | Address |
|---|---|---|
| ITA Partners, LLC. | President | 30875 SW Heater Rd., Sherwood, OR 97140 |
| Name | Role | Address |
|---|---|---|
| ITA Partners, LLC. | Director | 30875 SW Heater Rd., Sherwood, OR 97140 |
| Name | Role |
|---|---|
| SUPPORTIVE HOUSING CONSULTING, LLC | Vice President |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2021-03-23 | Mino, Isolina | No data |
| AMENDMENT | 2015-08-27 | No data | No data |
| CANCEL ADM DISS/REV | 2004-10-05 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2003-02-10 | 5617 NW 7 STREET, MIAMI, FL 33126 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1991-06-04 | 5617 NW 7TH STREET, MIAMI, FL 33126 | No data |
| CHANGE OF MAILING ADDRESS | 1991-06-04 | 5617 NW 7TH STREET, MIAMI, FL 33126 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-29 |
| ANNUAL REPORT | 2024-01-24 |
| AMENDED ANNUAL REPORT | 2023-08-11 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-01-26 |
| AMENDED ANNUAL REPORT | 2021-03-23 |
| ANNUAL REPORT | 2021-01-13 |
| ANNUAL REPORT | 2020-01-22 |
| ANNUAL REPORT | 2019-01-11 |
| ANNUAL REPORT | 2018-01-15 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
