| Entity Name: | HAVEN OF OUR LADY OF PEACE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Active |
| Date Filed: | 25 Jan 2000 (25 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 14 Sep 2000 (24 years ago) |
| Document Number: | N00000000461 |
| FEI/EIN Number | 593620346 |
| Address: | 1900 SUMMIT BLVD., PENSACOLA, FL, 32503 |
| Mail Address: | 1900 SUMMIT BLVD., PENSACOLA, FL, 32503, US |
| ZIP code: | 32503 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851321087 | 2006-07-04 | 2012-01-04 | PO BOX 2728, PENSACOLA, FL, 325132728, US | 1900 SUMMIT BLVD, PENSACOLA, FL, 325033359, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 850-416-7070 |
| Fax | 8504167453 |
| Phone | +1 850-436-5900 |
| Fax | 8504365959 |
Authorized person
| Name | MARTHA PEREZ |
| Role | ADMINISTRATOR |
| Phone | 8504365900 |
Taxonomy
| Taxonomy Code | 313M00000X - Nursing Facility/Intermediate Care Facility |
| Is Primary | No |
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS OF FLORIDA |
| Number | M3X |
| State | FL |
| Issuer | MEDICAID |
| Number | 025883100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Kron Sister Ellen DC | Member | 3393 McKelvey Road, Bridgeton, MO, 63044 |
| METHODIST HOMES FOR THE AGING CPRORATION | Member | 1900 SUMMIT BLVD., PENSACOLA, FL, 32503 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G01282900078 | HAVEN OF OUR LADY OF PEACE | ACTIVE | 2001-10-09 | 2026-12-31 | No data | 1900 SUMMIT BOULEVARD, PENSACOLA, FL, 32503 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2018-04-24 | 1900 SUMMIT BLVD., PENSACOLA, FL 32503 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-08-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-08-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-04-23 | 1900 SUMMIT BLVD., PENSACOLA, FL 32503 | No data |
| AMENDMENT | 2000-09-14 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-26 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-03-22 |
| ANNUAL REPORT | 2018-04-24 |
| Reg. Agent Change | 2017-08-17 |
| ANNUAL REPORT | 2017-04-07 |
| ANNUAL REPORT | 2016-04-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
