| Entity Name: | INDIAN ROCKS ASSISTED LIVING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Not For Profit Corporation |
| Status: | Inactive |
| Date Filed: | 21 Apr 2004 (21 years ago) |
| Date of dissolution: | 07 Apr 2017 (8 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 07 Apr 2017 (8 years ago) |
| Document Number: | N04000004117 |
| FEI/EIN Number | 03-0548503 |
| Address: | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Mail Address: | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| ZIP code: | 33774 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366865784 | 2014-01-22 | 2014-01-22 | 2050 E BAY DR, LARGO, FL, 337712321, US | 2050 E BAY DR, LARGO, FL, 337712321, US | |||||||||||||||||||||||
|
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| Phone | +1 727-559-7666 |
Authorized person
| Name | DAVE GERY |
| Role | ADMINISTRATOR |
| Phone | 7275997644 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10811 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142595100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FERGUSON, TIMOTHY A | Agent | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Name | Role | Address |
|---|---|---|
| HANNAN, BOB | Director | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| RAYMOND, HETTERICH | Director | 12685 Ulmerton Road, Largo, FL 33774 |
| FERGUSON, TIMOTHY A | Director | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Veltman, Greg | Director | 12685 Ulmerton Road, Largo, FL 33774 |
| Name | Role | Address |
|---|---|---|
| RAYMOND, HETTERICH | Treasurer | 12685 Ulmerton Road, Largo, FL 33774 |
| Name | Role | Address |
|---|---|---|
| FERGUSON, TIMOTHY A | President | 12685 ULMERTON ROAD, LARGO, FL 33774 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000117035 | HERON HOUSE INDIAN ROCKS | EXPIRED | 2013-12-02 | 2018-12-31 | No data | 2050 EAST BAY DRIVE, LARGO, FL, 33771 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2017-04-07 | No data | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2017-04-07 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-01-28 |
| ANNUAL REPORT | 2014-03-20 |
| ANNUAL REPORT | 2013-04-18 |
| ANNUAL REPORT | 2012-03-20 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-04-29 |
| ANNUAL REPORT | 2009-04-14 |
| ANNUAL REPORT | 2008-04-30 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
