| Entity Name: | HAMPTON MANOR, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Oct 2003 (21 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | P03000115399 |
| FEI/EIN Number | 061711309 |
| Address: | 1810 SE 16TH AVE, OCALA, FL, 34471, US |
| Mail Address: | 1810 SE 16TH AVE, OCALA, FL, 34471, US |
| ZIP code: | 34471 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114184512 | 2008-05-22 | 2008-05-22 | 1731 SW 2ND AVE, SUIT C, OCALA, FL, 34471, US | 1731 SW 2ND AVE, SUIT C, OCALA, FL, 34471, US | |||||||||||||||||||||||||
|
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| Phone | +1 352-387-1830 |
| Fax | 3528730237 |
Authorized person
| Name | MR. PEDER L JOHNSEN |
| Role | PRESIDENT |
| Phone | 3523871830 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10647 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 14400801 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSEN PEDER L | Agent | 1810 SE 16TH AVE, OCALA, FL, 34471 |
| Name | Role | Address |
|---|---|---|
| JOHNSEN PEDER | President | 1810 SE 16TH AVE, OCALA, FL, 34471 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-30 | 1810 SE 16TH AVE, OCALA, FL 34471 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-30 | 1810 SE 16TH AVE, OCALA, FL 34471 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-30 | 1810 SE 16TH AVE, OCALA, FL 34471 | No data |
| REGISTERED AGENT NAME CHANGED | 2010-04-30 | JOHNSEN, PEDER L | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J18000495143 | LAPSED | 08 CA 00896 | MARION CO | 2015-03-26 | 2023-07-16 | $22,000.00 | JOYCE FORTNER, 525 SE 35TH STREET, OCALA, FLAORIDA 34471 |
| J18000495184 | LAPSED | 08 CA 00896 | MARION CO | 2013-06-07 | 2023-07-16 | $295,000.00 | JOYCE FORTNER, 525 SE 35TH STREET, OCALA, FLORIDA 34471 |
| J12000218662 | LAPSED | 08-CA-00896 | CIRCUIT COURT FIFTH CIRCUIT | 2012-03-26 | 2017-03-27 | $250,676.00 | JOYCE FORTNER, 525 SE 35TH STREET, OCALA, FLORIDA 34471 |
| J10000945268 | LAPSED | 08-683-CC | MARION CNTY CRT | 2010-07-16 | 2015-09-28 | $110287.21 | FELDMAN, FO & MORGADO, P.A., 2701 N. ROCKY POINT DRIVE, SUITE 1000, TAMPA, FL 33607 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-30 |
| ANNUAL REPORT | 2012-04-26 |
| ANNUAL REPORT | 2011-04-27 |
| ANNUAL REPORT | 2010-04-30 |
| ANNUAL REPORT | 2009-04-21 |
| ANNUAL REPORT | 2008-03-03 |
| ANNUAL REPORT | 2007-05-01 |
| ANNUAL REPORT | 2006-04-28 |
| ANNUAL REPORT | 2005-04-28 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
