| Entity Name: | WESTBROOKE MANOR, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Dec 2005 (19 years ago) |
| Date of dissolution: | 25 Apr 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 25 Apr 2022 (3 years ago) |
| Document Number: | P05000161478 |
| FEI/EIN Number | 204787867 |
| Mail Address: | 800 Hamilton Dr, St Simons, GA, 31522, US |
| Address: | 6701 DAIRY RD, ZEPHRYHILLS, FL, 33542-6618 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528245875 | 2008-01-29 | 2011-03-11 | 6701 DAIRY RD, ZEPHYRHILLS, FL, 335426618, US | 6701 DAIRY RD, ZEPHYRHILLS, FL, 335426618, US | |||||||||||||||||||||||||
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| Phone | +1 813-782-4417 |
| Fax | 8137828781 |
Authorized person
| Name | MR. DOUGLAS MATTHEW KLINOWSKI |
| Role | PRESIDENT |
| Phone | 8137824417 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL6061 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 693714400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KLINOWSKI DOUGLAS M | Agent | 800 Hamilton Dr, St Simons, FL, 31522 |
| Name | Role | Address |
|---|---|---|
| Klinowski Douglas M | Chief Executive Officer | 800 Hamilton Dr, St Simons, GA, 31522 |
| Name | Role | Address |
|---|---|---|
| Klinowski Cynthia | President | 900 Rose Cottage Rd, St Simons, GA, 31522 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-04-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-03-17 | 800 Hamilton Dr, St Simons, FL 31522 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-17 | 6701 DAIRY RD, ZEPHRYHILLS, FL 33542-6618 | No data |
| REINSTATEMENT | 2015-10-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-10-06 | KLINOWSKI, DOUGLAS M | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-05-01 | 6701 DAIRY RD, ZEPHRYHILLS, FL 33542-6618 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000752835 | TERMINATED | 1000000345970 | PASCO | 2012-10-11 | 2032-10-25 | $ 6,641.68 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, PORT RICHEY SERVICE CENTER, 6709 RIDGE RD STE 300, PORT RICHEY FL346686842 |
| Name | Date |
|---|---|
| Voluntary Dissolution | 2022-04-25 |
| ANNUAL REPORT | 2021-03-17 |
| AMENDED ANNUAL REPORT | 2020-10-26 |
| ANNUAL REPORT | 2020-05-28 |
| ANNUAL REPORT | 2019-03-21 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-03-07 |
| REINSTATEMENT | 2015-10-06 |
| ANNUAL REPORT | 2014-04-25 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
