| Entity Name: | PALMS VILLA RETIREMENT HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Nov 2000 (24 years ago) |
| Document Number: | P00000107743 |
| FEI/EIN Number | 651056389 |
| Address: | 2131 NW 28TH ST, OAKLAND PARK, FL, 33311 |
| Mail Address: | 2131 NW 28TH ST, OAKLAND PARK, FL, 33311 |
| ZIP code: | 33311 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083866818 | 2008-10-10 | 2020-08-26 | 2131 NW 28TH ST, OAKLAND PARK, FL, 333112136, US | 2131 NW 28TH ST, OAKLAND PARK, FL, 333112136, US | |||||||||||||||||||||||||
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| Phone | +1 954-484-1350 |
| Fax | 9545270505 |
Authorized person
| Name | JASON KISSOONLAL |
| Role | PRESIDENT |
| Phone | 9544841350 |
Taxonomy
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| License Number | AL4990 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140622100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Kissoonlal Jason | Agent | 2131 NW 28TH ST, OAKLAND PARK, FL, 33311 |
| Name | Role |
|---|---|
| PALMS VILLA RETIREMENT HOME, INC. | Director |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000128051 | PALMS VILLA | ACTIVE | 2016-11-29 | 2026-12-31 | No data | 2131 NW 28TH STREET, OAKLAND PARK, FL, 33311 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2024-04-21 | Kissoonlal, Jason | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-06 | 2131 NW 28TH ST, OAKLAND PARK, FL 33311 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-06 | 2131 NW 28TH ST, OAKLAND PARK, FL 33311 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-06 | 2131 NW 28TH ST, OAKLAND PARK, FL 33311 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-21 |
| ANNUAL REPORT | 2023-04-18 |
| ANNUAL REPORT | 2022-04-06 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-06-09 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-25 |
| ANNUAL REPORT | 2016-04-18 |
| ANNUAL REPORT | 2015-04-22 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6043957310 | 2020-04-30 | 0455 | PPP | 2131 NW 28TH ST, OAKLAND PARK, FL, 33311-2136 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Feb 2025
Sources: Florida Department of State
