| Entity Name: | GROWN FOLKS ADULT SOCIAL CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 Mar 2011 (14 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P11000022907 |
| FEI/EIN Number | 800703935 |
| Address: | 10825 NATALIE DR E, JACKSONVILLE, FL, 32218 |
| Mail Address: | PO BOX 17001, JACKSONVILLE, FL, 32245 |
| ZIP code: | 32218 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1376890301 | 2012-08-09 | 2012-08-09 | 1823 UNIVERSITY BLVD. S., JACKSONVILLE, FL, 322168930, US | 1823 UNIVERSITY BLVD S, JACKSONVILLE, FL, 322168930, US | |||||||||||||||||||||||||
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| Phone | +1 904-329-3503 |
| Fax | 9043293505 |
Authorized person
| Name | MRS. ANITA BURNEY |
| Role | PRESIDENT |
| Phone | 9043293503 |
Taxonomy
| Taxonomy Code | 311ZA0620X - Adult Care Home Facility |
| License Number | 9196 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004757200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BURNEY WANZA JR | Agent | 1823 UNIVERSITY BOULEVARD, JACKSONVILLE, FL, 32207 |
| Name | Role | Address |
|---|---|---|
| BURNEY ANITA L | President | 1823 UNIVERSITY BLVD.S, JACKSONVILLE, FL, 32216 |
| Name | Role | Address |
|---|---|---|
| BURNEY WANZA JR | Vice President | 1823 UNIVERSITY BOULEVARD, JACKSONVILLE, FL, 32216 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2013-09-17 | 10825 NATALIE DR E, JACKSONVILLE, FL 32218 | No data |
| CHANGE OF MAILING ADDRESS | 2013-09-17 | 10825 NATALIE DR E, JACKSONVILLE, FL 32218 | No data |
| REINSTATEMENT | 2013-03-04 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2012-09-28 | No data | No data |
| AMENDMENT | 2011-12-22 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2013-03-04 |
| Amendment | 2011-12-22 |
| ADDRESS CHANGE | 2011-03-22 |
| Domestic Profit | 2011-03-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
