| Entity Name: | HAILES BOARDING HOME, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Mar 2015 (10 years ago) |
| Date of dissolution: | 25 Sep 2020 (4 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2020 (4 years ago) |
| Document Number: | P15000023324 |
| FEI/EIN Number | 47-3080379 |
| Address: | 1009 NORTH WILLOW AVENUE, TAMPA, FL, 33607 |
| Mail Address: | 1009 NORTH WILLOW AVENUE, TAMPA, FL, 33607 |
| ZIP code: | 33607 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154572246 | 2008-10-07 | 2008-10-07 | 1009 N WILLOW AVE, TAMPA, FL, 336075549, US | 1009 N. WILLOW AVE., TAMPA, FL, 33607, US | |||||||||||||||||||||||||
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| Phone | +1 813-251-1327 |
| Fax | 8132599928 |
Authorized person
| Name | ADRIANNE R WILSON |
| Role | ADMINISTRATOR |
| Phone | 8132511327 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL9732 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140354100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CAUFMAN THOMAS W | Agent | 1410 North Westshore Blvd. #200, TAMPA, FL, 33607 |
| Name | Role | Address |
|---|---|---|
| JONES ANDREA | President | 1009 NORTH WILLOW AVENUE, TAMPA, FL, 33607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-08-16 | 1410 North Westshore Blvd. #200, TAMPA, FL 33607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2019-03-12 |
| ANNUAL REPORT | 2018-02-01 |
| ANNUAL REPORT | 2017-02-13 |
| ANNUAL REPORT | 2016-08-16 |
| Domestic Profit | 2015-03-09 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
