| Entity Name: | WILLOW HAVEN ALF, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 15 Oct 2003 (21 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P03000114384 |
| FEI/EIN Number | 200306131 |
| Address: | 1220 NE 207 STREET, MIAMI, FL, 33179 |
| Mail Address: | 1220 NE 207 STREET, MIAMI, FL, 33179 |
| ZIP code: | 33179 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053520809 | 2007-05-21 | 2011-07-24 | 1220 NE 207TH ST, NORTH MIAMI BEACH, FL, 331792019, US | 1220 NE 207TH ST, NORTH MIAMI BEACH, FL, 331792019, US | |||||||||||||||||||||||
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| Phone | +1 305-653-3894 |
Authorized person
| Name | BLANCA PEREZ |
| Role | DIRECTOR |
| Phone | 3056533894 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 10457 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142152200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PEREZ BLANCA | Agent | 1220 NE 207 STREET, MIAMI, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| PEREZ BLANCA | President | 1220 NE 207 STREET, MIAMI, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| PEREZ BLANCA | Director | 1220 NE 207 STREET, MIAMI, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-04-26 |
| ANNUAL REPORT | 2015-04-29 |
| ANNUAL REPORT | 2014-04-23 |
| ANNUAL REPORT | 2013-04-24 |
| ANNUAL REPORT | 2012-04-23 |
| ANNUAL REPORT | 2011-04-27 |
| ANNUAL REPORT | 2010-04-27 |
| ANNUAL REPORT | 2009-04-30 |
| ANNUAL REPORT | 2008-03-31 |
| ANNUAL REPORT | 2007-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
