| Entity Name: | FAIRGREEN ASSISTED LIVING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Domestic Profit
FAIRGREEN ASSISTED LIVING, INC. is structured as a Domestic Profit Corporation, which, in Florida signifies a Profit Corporation (also known as a C-Corporation). This business structure is recognized as a separate legal entity from its owners. This offers shareholders the benefit of limited liability protection, safeguarding their personal assets from the corporation's debts and obligations, and facilitates raising capital through the issuance of stock. In Florida, Domestic Profit Corporations are governed by Title XXXVI, Chapter 607, Florida Statutes – Florida Business Corporation Act. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 15 Mar 2004 (21 years ago) |
| Document Number: | P04000049511 |
| FEI/EIN Number |
200949437
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL, 32168 |
| Mail Address: | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL, 32168 |
| ZIP code: | 32168 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184059750 | 2013-09-13 | 2013-09-13 | 1150 WAYNE AVE, NEW SMYRNA BEACH, FL, 321686132, US | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL, 32168, US | |||||||||||||||||||||||||
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| Phone | +1 386-428-3018 |
| Fax | 3864287485 |
Authorized person
| Name | MRS. JESUSA H. KEPLER |
| Role | OWNER/ADMINISTRATOR |
| Phone | 3864283018 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL11072 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1150 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KEPLER JESUSA H | President | 1150 WAYNE AVE, NEW SMYRNA BEACH, FL, 32168 |
| KEPLER JESUSA H | Agent | 1150 WAYNE AVE, NEW SMYRNA BEACH, FL, 32168 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000067845 | FAIRGREEN ASSISTED LIVING FACILITY INC. | EXPIRED | 2019-06-14 | 2024-12-31 | - | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL, 32168 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2009-04-23 | 1150 WAYNE AVE, NEW SMYRNA BEACH, FL 32168 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2007-05-24 | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL 32168 | - |
| CHANGE OF MAILING ADDRESS | 2007-05-24 | 1150 WAYNE AVE., NEW SMYRNA BEACH, FL 32168 | - |
| REGISTERED AGENT NAME CHANGED | 2005-03-11 | KEPLER, JESUSA H | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-25 |
| ANNUAL REPORT | 2023-02-16 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-02-13 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-02-17 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-04-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 8673547309 | 2020-05-01 | 0491 | PPP | 1150 WAYNE AVE, NEW SMYRNA, FL, 32168-6132 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 6269388903 | 2021-05-01 | 0491 | PPS | 1150 Wayne Ave, New Smyrna Beach, FL, 32168-6132 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 01 Apr 2025
Sources: Florida Department of State
