| Entity Name: | OAK GROVE ASSISTED LIVING FACILITY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 03 Mar 2021 (4 years ago) |
| Date of dissolution: | 25 Jul 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Jul 2022 (3 years ago) |
| Document Number: | L21000104016 |
| FEI/EIN Number | 86-2606913 |
| Address: | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL, 34601, US |
| Mail Address: | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL, 34601, US |
| ZIP code: | 34601 |
| County: | Hernando |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982371233 | 2021-08-25 | 2021-08-25 | 21107 BIRCHOLM CT, LAND O LAKES, FL, 346377464, US | 5483 NEFF LAKE RD, BROOKSVILLE, FL, 346017842, US | |||||||||||||||||||||
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| Phone | +1 720-244-9712 |
| Phone | +1 352-796-3733 |
Authorized person
| Name | JASON PETERSEN |
| Role | OWNER |
| Phone | 7202449712 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 111276900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PETERSEN JASON J | Agent | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL, 34601 |
| Name | Role | Address |
|---|---|---|
| PETERSEN JASON J | Manager | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL, 34601 |
| PETERSEN GLADIES V | Manager | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL, 34601 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-07-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-07-14 | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL 34601 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-07-25 |
| ANNUAL REPORT | 2022-07-14 |
| Florida Limited Liability | 2021-03-03 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
