| Entity Name: | SHADY OAKS REST HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 27 Jul 2010 (15 years ago) |
| Document Number: | P10000061622 |
| FEI/EIN Number | 46-5453621 |
| Address: | 1208 KENNEDY ROAD, DAYTONA BEACH, FL, 32117 |
| Mail Address: | 1208 KENNEDY ROAD, DAYTONA BEACH, FL, 32117 |
| ZIP code: | 32117 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699036285 | 2012-05-31 | 2014-10-27 | 1208 KENNEDY RD, DAYTONA BEACH, FL, 32117, US | 1208 KENNEDY RD, DAYTONA BEACH, FL, 32117, US | |||||||||||||||||||||||||
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| Phone | +1 386-253-6993 |
Authorized person
| Name | MR. JAMES HAM |
| Role | MANAGER |
| Phone | 3865620870 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10293 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 10293 |
| State | FL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHADY OAKS REST HOME INC. 401 K PROFIT SHARING PLAN TRUST | 2015 | 465453621 | 2016-06-14 | SHADY OAKS REST HOME INC | 0 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2016-06-14 |
| Name of individual signing | JAMES HAM |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Ham Chi y | Agent | 1208 KENNEDY ROAD, DAYTONA BEACH, FL, 32117 |
| Name | Role | Address |
|---|---|---|
| HAM CHI | President | 1208 KENNEDY ROAD, DAYTONA BEACH, FL, 32117 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2013-01-24 | Ham, Chi y | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-01-24 | 1208 KENNEDY ROAD, DAYTONA BEACH, FL 32117 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-13 |
| ANNUAL REPORT | 2023-04-19 |
| ANNUAL REPORT | 2022-02-17 |
| ANNUAL REPORT | 2021-03-23 |
| ANNUAL REPORT | 2020-03-04 |
| ANNUAL REPORT | 2019-02-19 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-29 |
| ANNUAL REPORT | 2015-01-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
