| Entity Name: | ACADEMY ASSISTED LIVING FACILITY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 Apr 2004 (21 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 06 May 2004 (21 years ago) |
| Document Number: | P04000066655 |
| FEI/EIN Number | 542151149 |
| Address: | 1225 SOLTMAN AVE, FORT PIERCE, FL, 34950 |
| Mail Address: | 702 MAYKKA RIVER TRACE, PORT ST LUCIE, FL, 34986 |
| ZIP code: | 34950 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326399833 | 2012-09-24 | 2012-09-24 | 1225 SOLTMAN AVE, FORT PIERCE, FL, 349506571, US | 1225 SOLTMAN AVE, FORT PIERCE, FL, 349506571, US | |||||||||||||||||||||||||
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| Phone | +1 772-460-1211 |
| Fax | 7724607679 |
Authorized person
| Name | MRS. RAJWANTIE LAL |
| Role | ADMINASTRATOR |
| Phone | 7724601211 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL 7824 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 687422300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Academy Assisted Living | Agent | 702 MAYKKA RIVER TRACE, PORT ST LUCIE, FL, 34986 |
| Name | Role | Address |
|---|---|---|
| SULLY MARIE O | Director | 702 MAYKKA RIVER TRACE, PORT ST LUCIE, FL, 34986 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-03-24 | Academy Assisted Living | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-08 | 1225 SOLTMAN AVE, FORT PIERCE, FL 34950 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-08 | 1225 SOLTMAN AVE, FORT PIERCE, FL 34950 | No data |
| AMENDMENT | 2004-05-06 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-25 |
| ANNUAL REPORT | 2023-03-24 |
| ANNUAL REPORT | 2022-03-10 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-04-02 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-02-27 |
| ANNUAL REPORT | 2017-02-05 |
| ANNUAL REPORT | 2016-01-17 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
