| Entity Name: | HAMPTON BELLEVIEW ALF, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Feb 2021 (4 years ago) |
| Document Number: | L21000078080 |
| FEI/EIN Number | NOT APPLICABLE |
| Mail Address: | 1810 SE 16th Ave., Ocala, FL, 34471, US |
| Address: | 10590 SE 62nd Ave. Road, Belleview, FL, 34420, US |
| ZIP code: | 34420 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528796885 | 2022-08-12 | 2022-08-12 | 1740 SE 18TH ST STE 902, OCALA, FL, 344715445, US | 10590 SE 62ND AVENUE RD, BELLEVIEW, FL, 344203004, US | |||||||||||||||||||||||
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| Phone | +1 352-387-1830 |
| Fax | 3524330728 |
| Phone | +1 352-245-6201 |
Authorized person
| Name | PEDER JOHNSEN |
| Role | CEO |
| Phone | 3523871830 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114712500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Johnsen Peder | Agent | 1810 SE 16th Ave., Ocala, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| Johnsen Peder | Manager | 2216 S Occident St, Tampa, FL, 33629 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-10-21 | 10590 SE 62nd Ave. Road, Belleview, FL 34420 | No data |
| CHANGE OF MAILING ADDRESS | 2024-10-21 | 10590 SE 62nd Ave. Road, Belleview, FL 34420 | No data |
| REGISTERED AGENT NAME CHANGED | 2024-10-21 | Johnsen, Peder | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-10-21 | 1810 SE 16th Ave., Ocala, FL 34471 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-10-21 |
| AMENDED ANNUAL REPORT | 2024-09-16 |
| ANNUAL REPORT | 2024-01-31 |
| ANNUAL REPORT | 2023-03-20 |
| ANNUAL REPORT | 2022-02-02 |
| Florida Limited Liability | 2021-02-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
