| Entity Name: | ISLAND SPLENDOR ALF, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 31 Oct 2005 (19 years ago) |
| Document Number: | P05000145860 |
| FEI/EIN Number | 203731972 |
| Address: | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Mail Address: | 1155 18TH AVENUE SW, LARGO, FL, 33778, US |
| ZIP code: | 33778 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801217914 | 2013-12-17 | 2013-12-17 | 1155 18TH AVE SW, LARGO, FL, 337781116, US | 9057 109TH AVE, SEMINOLE, FL, 337771115, US | |||||||||||||||||||||||||
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| Phone | +1 727-585-9788 |
| Fax | 7272046549 |
Authorized person
| Name | MS. ELSA JOHNSON |
| Role | ADMINISTRATOR |
| Phone | 7275859788 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL11915 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003477600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON ELSA M | Agent | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| JOHNSON ELSA M | President | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| JOHNSON ELSA M | Secretary | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| JOHNSON ELSA M | Treasurer | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| JOHNSON ELSA M | Director | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Name | Role | Address |
|---|---|---|
| SMITH CEDRIC | Officer | 1155 18TH AVENUE SW, LARGO, FL, 33778 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000100235 | ISLAND SPLENDOR ASSISTED LIVING | ACTIVE | 2016-09-13 | 2026-12-31 | No data | 1155 18TH AVE. SW, LARGO, FL, 33778 |
| G16000100042 | ISLAND SPLENDOR ASSISTED LIVING FACILITY#1 | EXPIRED | 2016-09-12 | 2021-12-31 | No data | 1155 18TH AVE., S. W., LARGO, FL, 33778 |
| G10000054886 | ISLAND SPLENDOR ASSISTED LIVING FACILITY #1 | EXPIRED | 2010-06-16 | 2015-12-31 | No data | 1155 18TH AVENUE S.W., LARGO, FL, 33778-1116 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2013-01-09 | 1155 18TH AVENUE SW, LARGO, FL 33778 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-01-21 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-09 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-03-23 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
