| Entity Name: | CRESTWOOD NURSING CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 19 Jul 2005 (20 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P05000100898 |
| FEI/EIN Number | 51-0548422 |
| Address: | 995 Canton St., Suite 100, Roswell, GA 30075 |
| Mail Address: | 995 Canton St., Suite 100, Roswell, GA 30075 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023010071 | 2005-08-10 | 2019-07-18 | 995 CANTON ST STE 100, ROSWELL, GA, 300754240, US | 501 S PALM AVE, PALATKA, FL, 321774147, US | |||||||||||||||||||||
|
|||||||||||||||||||||||||
| Fax | 3863251531 |
| Phone | +1 386-328-1472 |
Authorized person
| Name | ROBERT HAGAN |
| Role | PRESIDENT |
| Phone | 7709934000 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031227400 |
| State | FL |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| HAGAN, ROBERT W | Chief Executive Officer | 995 CANTON STREET, SUITE 100 ROSWELL, GA 30075 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2022-04-20 | 995 Canton St., Suite 100, Roswell, GA 30075 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2022-04-20 | 995 Canton St., Suite 100, Roswell, GA 30075 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-25 | 7901 4TH STREET NORTH, SUITE 300, ST.PETERSBURG, FL 33702 | No data |
| REGISTERED AGENT NAME CHANGED | 2014-04-14 | Registered Agents Inc. | No data |
| CANCEL ADM DISS/REV | 2006-11-03 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
| ARTICLES OF CORRECTION | 2005-07-28 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-20 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-06-11 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-03-09 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-29 |
| ANNUAL REPORT | 2015-04-08 |
| ANNUAL REPORT | 2014-04-14 |
| ANNUAL REPORT | 2013-04-23 |
Date of last update: 28 Jan 2025
Sources: Florida Department of State
