| Entity Name: | DOUGLAS ASSISTED LIVING FACILITY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| 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: | 21 May 2002 (23 years ago) |
| Date of dissolution: | 01 Oct 2004 (21 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 01 Oct 2004 (21 years ago) |
| Document Number: | N02000003901 |
| FEI/EIN Number |
043675424
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| Mail Address: | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| ZIP code: | 32055 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1417392150 | 2013-05-08 | 2013-05-08 | 769 NE GURLEY AVE, LAKE CITY, FL, 320552453, US | 769 NE GURLEY AVE, LAKE CITY, FL, 320552453, US | |||||||||||||||||||||||
|
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| Phone | +1 386-755-3304 |
Authorized person
| Name | MARY ALYCE CARTER |
| Role | OWNER/ADMINISTRATOR |
| Phone | 3867553304 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7558 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1402340 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARTER MARY | President | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| CARTER NATHAN | Vice President | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| CARTER NATHAN | Treasurer | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| INGRAM DEBORAH | Secretary | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| INGRAM DEBORAH | Treasurer | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| CARTER MARY | Agent | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| CARTER MARY | Director | N.E. 769 GURLEY AVE., LAKE CITY, FL, 32055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2004-10-01 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2003-05-20 | N.E. 769 GURLEY AVE., LAKE CITY, FL 32055 | - |
| CHANGE OF MAILING ADDRESS | 2003-05-20 | N.E. 769 GURLEY AVE., LAKE CITY, FL 32055 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2003-05-20 | N.E. 769 GURLEY AVE., LAKE CITY, FL 32055 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2003-05-20 |
| Domestic Non-Profit | 2002-05-21 |
Date of last update: 01 Apr 2025
Sources: Florida Department of State
