| Entity Name: | SERENITY GARDENS RETIREMENT HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Mar 2005 (20 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P05000040519 |
| FEI/EIN Number | 753192871 |
| Address: | 6200 CLEVELAND STREET, HOLLYWOOD, FL, 33024, US |
| Mail Address: | 6200 CLEVELAND STREET, HOLLYWOOD, FL, 33024, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285949040 | 2010-08-17 | 2010-08-17 | 6200 CLEVELAND ST, HOLLYWOOD, FL, 330245914, US | 6200 CLEVELAND ST, HOLLYWOOD, FL, 330245914, US | |||||||||||||||||||||
|
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| Phone | +1 954-983-5174 |
| Fax | 9549649892 |
Authorized person
| Name | MISS BLOSSOM KEATON |
| Role | ADMINISTRATOR/OWNER |
| Phone | 9548224829 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001412200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KEATON BLOSSOM S | Agent | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| KEATON BLOSSOM P | President | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| KEATON BLOSSOM P | Treasurer | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| KEATON BLOSSOM P | Secretary | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL, 33068 |
| Name | Role | Address |
|---|---|---|
| KEATON BLOSSOM P | Director | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL, 33068 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REINSTATEMENT | 2011-03-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-05-01 | 8250 SOUTH WEST 4TH STREET, NORTH LAUDERDALE, FL 33068 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-05-01 | 6200 CLEVELAND STREET, HOLLYWOOD, FL 33024 | No data |
| CHANGE OF MAILING ADDRESS | 2006-05-01 | 6200 CLEVELAND STREET, HOLLYWOOD, FL 33024 | No data |
| REGISTERED AGENT NAME CHANGED | 2006-05-01 | KEATON, BLOSSOM S | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-04-30 |
| ANNUAL REPORT | 2014-04-30 |
| ANNUAL REPORT | 2013-04-25 |
| ANNUAL REPORT | 2012-04-23 |
| REINSTATEMENT | 2011-03-03 |
| ANNUAL REPORT | 2009-04-30 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-04-28 |
| ANNUAL REPORT | 2006-05-01 |
| Domestic Profit | 2005-03-17 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
