| Entity Name: | CROSSTOWN FAMILY CARE HOME,INC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 25 Jul 2017 (8 years ago) |
| Date of dissolution: | 27 Sep 2019 (5 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2019 (5 years ago) |
| Document Number: | P17000062841 |
| FEI/EIN Number | 82-2276878 |
| Address: | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| Mail Address: | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| ZIP code: | 34953 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1851848436 | 2016-09-01 | 2017-09-25 | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL, 349531329, US | 1850 SW MACKENZIE ST, PORT ST LUCIE, FL, 349531329, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-667-5616 |
| Fax | 7723332894 |
Authorized person
| Name | NELLIE JOHNSON |
| Role | DIRECTOR |
| Phone | 9546675616 |
Taxonomy
| Taxonomy Code | 251S00000X - Community/Behavioral Health Agency |
| Is Primary | No |
| Taxonomy Code | 261QA0600X - Adult Day Care Clinic/Center |
| Is Primary | No |
| Taxonomy Code | 311Z00000X - Custodial Care Facility |
| Is Primary | Yes |
| Taxonomy Code | 311ZA0620X - Adult Care Home Facility |
| Is Primary | No |
| Taxonomy Code | 320800000X - Mental Illness Community Based Residential Treatment Facility |
| Is Primary | No |
| Taxonomy Code | 347C00000X - Private Vehicle |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 678513 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOHNSON, NELLIE A | Agent | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| JOHNSON, NELLIE A | President | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| DARIUS, SANDRA | Vice President | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| Name | Role | Address |
|---|---|---|
| NICHOLSON, HOWARD | Treasurer | 1850 SOUTHWEST MACKENZIE STREET, PORT ST LUCIE, FL 34953 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2018-04-26 |
| Domestic Profit | 2017-07-25 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
