| Entity Name: | MAGNOLIA MANOR ASSISTED LIVING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Mar 2010 (15 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 17 Jun 2016 (9 years ago) |
| Document Number: | P10000025172 |
| FEI/EIN Number | 272184599 |
| Address: | 17420 OLD TOBACCO ROAD, LUTZ, FL, 33558, US |
| Mail Address: | 17420 OLD TOBACCO ROAD, LUTZ, FL, 33558, US |
| ZIP code: | 33558 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982951067 | 2012-08-08 | 2012-08-08 | 17420 OLD TOBACCO RD, LUTZ, FL, 335584979, US | 17420 OLD TOBACCO RD, LUTZ, FL, 335584979, US | |||||||||||||||||
|
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| Phone | +1 813-918-0588 |
Authorized person
| Name | BARBARA KEITHLY |
| Role | PRESIDENT |
| Phone | 8139180588 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL12096 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| KEITHLY BARBARA F | Agent | 17420 OLD TOBACCO ROAD, LUTZ, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| KEITHLY BARBARA F | President | 17420 OLD TOBACCO ROAD, LUTZ, FL, 33558 |
| Name | Role | Address |
|---|---|---|
| Lozano Robbin F | Vice President | 17420 OLD TOBACCO ROAD, LUTZ, FL, 33558 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2019-01-22 | 17420 OLD TOBACCO ROAD, LUTZ, FL 33558 | No data |
| AMENDMENT | 2016-06-17 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2013-02-25 | 17420 OLD TOBACCO ROAD, LUTZ, FL 33558 | No data |
| REGISTERED AGENT NAME CHANGED | 2011-01-08 | KEITHLY, BARBARA F | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-30 |
| ANNUAL REPORT | 2023-01-31 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-02 |
| ANNUAL REPORT | 2020-01-10 |
| ANNUAL REPORT | 2019-01-22 |
| ANNUAL REPORT | 2018-03-08 |
| ANNUAL REPORT | 2017-01-09 |
| Amendment | 2016-06-17 |
| ANNUAL REPORT | 2016-01-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
