| Entity Name: | ANGEL GUARDIAN ASSISTED LIVING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Jun 2004 (21 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | P04000094339 |
| FEI/EIN Number | 201244764 |
| Address: | 280, BAHAMA DR., FL, 32952 |
| Mail Address: | ANGEL GUARDIAN ASSISTED LIVING, 280 BAHAMA DR., MERRITT ISLAND, FL, 32952, US |
| ZIP code: | 32952 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649699265 | 2014-04-10 | 2020-05-21 | 280 BAHAMA DR., MERRITT ISLAND, FL, 32952, US | 280 BAHAMA DR, MERRITT ISLAND, FL, 329523605, US | |||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 321-848-0255 |
Authorized person
| Name | MS. ROSEANN J SIMONE |
| Role | ADMINISTRATOR |
| Phone | 3212238371 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10561 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PERSONAL SOCIAL SECURITY |
| Number | $$$$$$$$$ |
| State | NY |
| Issuer | AHCA LICENSE # |
| Number | AL10561 |
| State | FL |
| Issuer | PERSONAL NPI # |
| Number | 1184967184 |
| State | FL |
| Issuer | MEDICAID |
| Number | 008458000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIMONE ROSEANN J | Agent | 3165 NORTH ATLANTIC AVE, COCOA BEACH, FL, 32931 |
| Name | Role | Address |
|---|---|---|
| SIMONE ROSEANN J | President | 3165 NORTH ATLANTIC AVE, COCOA BEACH, FL, 32931 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-01-18 | 280, BAHAMA DR., FL 32952 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-18 | 3165 NORTH ATLANTIC AVE, B403, COCOA BEACH, FL 32931 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-04-25 | 280, BAHAMA DR., FL 32952 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-04-14 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-01-12 |
| ANNUAL REPORT | 2016-01-18 |
| ANNUAL REPORT | 2015-01-23 |
| ANNUAL REPORT | 2014-01-12 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-02-01 |
| ANNUAL REPORT | 2011-04-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
