| Entity Name: | ELDERLY LIVING CENTER OF HOLLY HILL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 23 May 2000 (25 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 29 Apr 2011 (14 years ago) |
| Document Number: | P00000050456 |
| FEI/EIN Number | 593647481 |
| Address: | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Mail Address: | 810 WEST OLEANDER, HOLLY HILL, FL, 32117, US |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366210809 | 2023-12-14 | 2023-12-18 | 810 OLEANDER AVE, HOLLY HILL, FL, 321173434, US | 810 OLEANDER AVE, HOLLY HILL, FL, 321173434, US | |||||||||||||||||||
|
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| Phone | +1 407-810-7841 |
Authorized person
| Name | KELLY DALE LUCAS |
| Role | PRESIDENT |
| Phone | 4078107841 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 102518900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Lucas Kelly Preside | Agent | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| Lucas Kelly D | President | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| Lucas Kelly D | Secretary | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| Lucas Kelly D | Treasurer | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| Lucas Kelly D | Director | 810 WEST OLEANDER, HOLLY HILL, FL, 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2015-04-09 | Lucas, Kelly, President | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-28 | 810 WEST OLEANDER, HOLLY HILL, FL 32117 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-28 | 810 WEST OLEANDER, HOLLY HILL, FL 32117 | No data |
| REINSTATEMENT | 2011-04-29 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-03-31 |
| ANNUAL REPORT | 2022-03-12 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-05-14 |
| ANNUAL REPORT | 2017-04-26 |
| ANNUAL REPORT | 2016-04-28 |
| AMENDED ANNUAL REPORT | 2015-06-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
