| Entity Name: | OAK GROVE ASSISTED LIVING FACILITY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
OAK GROVE ASSISTED LIVING FACILITY, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| 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
Federal Employer Identification (FEI) Number assigned by the IRS. |
| 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 |
| 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 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-07-14 | 5483 NEFF LAKE ROAD, BROOKSVILLE, FL 34601 | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-07-25 |
| ANNUAL REPORT | 2022-07-14 |
| Florida Limited Liability | 2021-03-03 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
