| Entity Name: | ANNIE'S RETIREMENT HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 09 Feb 2005 (20 years ago) |
| Document Number: | P05000021396 |
| FEI/EIN Number | 202339706 |
| Address: | 1650 N.E. 62nd STREET, FT. LAUDERDALE, FL, 33334, US |
| Mail Address: | 1650 N.E. 62nd STREET, FT. LAUDERDALE, FL, 33334, US |
| ZIP code: | 33334 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649629528 | 2016-06-10 | 2016-06-10 | 1650 NE 62ND STREET, FORT LAUDERDALE, FL, 33334, US | 1650 NE 62ND ST, FORT LAUDERDALE, FL, 333345140, US | |||||||||||||||||||||||
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| Phone | +1 954-772-6551 |
Authorized person
| Name | MRS. ANA MARIA LLAZA |
| Role | ADMINISTRATOR |
| Phone | 9547726551 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 8184 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 017156100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Llaza ANA M | Agent | 1650 N.E. 62 STREET, FT. LAUDERDALE, FL, 33334 |
| Name | Role | Address |
|---|---|---|
| Llaza ANA M | President | 1650 N.E. 62 STREET, FT. LAUDERDALE, FL, 33334 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-08-10 | 1650 N.E. 62nd STREET, FT. LAUDERDALE, FL 33334 | No data |
| CHANGE OF MAILING ADDRESS | 2015-08-10 | 1650 N.E. 62nd STREET, FT. LAUDERDALE, FL 33334 | No data |
| REGISTERED AGENT NAME CHANGED | 2015-08-10 | Llaza, ANA M | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-02-23 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-03-24 |
| ANNUAL REPORT | 2020-06-06 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-07 |
| ANNUAL REPORT | 2017-04-01 |
| ANNUAL REPORT | 2016-01-16 |
| AMENDED ANNUAL REPORT | 2015-08-10 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3215258900 | 2021-04-27 | 0455 | PPP | 1650 NE 62nd St, Fort Lauderdale, FL, 33334-5140 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Feb 2025
Sources: Florida Department of State
