| Entity Name: | BAY PORT ASSISTED LIVING INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 14 Jul 2016 (9 years ago) |
| Document Number: | P16000061089 |
| FEI/EIN Number | 81-5090993 |
| Address: | 110 EGLIN PKWY S.E., FORT WALTON BEACH, FL 32548 |
| Mail Address: | 110 EGLIN PKWY S.E., FORT WALTON BEACH, FL 32548 |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679290753 | 2022-10-20 | 2022-10-20 | 2573 BARRINGTON CIR, TALLAHASSEE, FL, 323086805, US | 243 HOLLYWOOD BLVD NW, FORT WALTON BEACH, FL, 325484783, US | |||||||||||||||||||
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| Phone | +1 850-601-9157 |
Authorized person
| Name | SETH WALKER |
| Role | CFO |
| Phone | 8505837990 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 114167800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BRUNER, VINCE | Agent | 110 EGLIN PKWY S.E., FORT WALTON BEACH, FL 32548 |
| Name | Role | Address |
|---|---|---|
| BRUNER, VINCE | President | 110 EGLIN PKWY S.E., FORT WALTON BEACH, FL 32548 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000055316 | BAY PORT OF FORT WALTON BEACH | ACTIVE | 2021-04-22 | 2026-12-31 | No data | 110 EGLIN PARKWAY S.E., FORT WALTON BEACH, FL, 32548 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-08 |
| ANNUAL REPORT | 2022-04-28 |
| ANNUAL REPORT | 2021-07-27 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-03-28 |
| ANNUAL REPORT | 2018-05-01 |
| ANNUAL REPORT | 2017-04-18 |
| Domestic Profit | 2016-07-14 |
Date of last update: 19 Jan 2025
Sources: Florida Department of State
