| Entity Name: | MOUNTAIN HIGH ASSISTED LIVING FACILITY INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 07 May 2012 (13 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | P12000042444 |
| FEI/EIN Number | 27-1748917 |
| Address: | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| Mail Address: | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| ZIP code: | 33610 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801236054 | 2013-07-02 | 2013-07-02 | 3906 E CURTIS ST, TAMPA, FL, 336106634, US | 3906 E CURTIS ST, TAMPA, FL, 336106634, US | |||||||||||||||||||||||||
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| Phone | +1 813-402-2116 |
| Fax | 8134424463 |
Authorized person
| Name | MRS. TONYA LASHAWN BELL |
| Role | OWNER/ADMINISTRATOR |
| Phone | 8137641269 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL12220 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002334200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BURR TRACY J | Agent | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| Name | Role | Address |
|---|---|---|
| BURR TRACY L | President | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| Name | Role | Address |
|---|---|---|
| BELL TONYA L | Vice President | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| STEPHENS JAMMIE S | Vice President | 3906 E CURTIS ST, TAMPA, FL, 33610 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| REINSTATEMENT | 2016-11-10 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-11-10 | BURR, TRACY JR | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| Name | Date |
|---|---|
| REINSTATEMENT | 2016-11-10 |
| ANNUAL REPORT | 2014-05-01 |
| ANNUAL REPORT | 2013-02-19 |
| Domestic Profit | 2012-05-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
