| Entity Name: | THERAPEUTIC ASSISTED LIVING CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 26 Nov 2019 (5 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 28 Sep 2022 (2 years ago) |
| Document Number: | P19000090814 |
| FEI/EIN Number | 84-3805381 |
| Address: | 25 LYNDENHURST LN,, PALM COAST, FL, 32137 |
| Mail Address: | 25 LYNDENHURST LN,, PALM COAST, FL, 32137 |
| ZIP code: | 32137 |
| County: | Flagler |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1164018214 | 2020-12-14 | 2020-12-14 | 25 LYNDENHURST LN, PALM COAST, FL, 321379521, US | 25 LYNDENHURST LN, PALM COAST, FL, 321379521, US | |||||||||||||||||||||||||
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| Phone | +1 904-501-8991 |
| Fax | 8447690772 |
Authorized person
| Name | LATASHA D GILYARD |
| Role | ALF ADMINISTRATOR |
| Phone | 9045018991 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| Is Primary | Yes |
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 108468900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Rowell LATASHA D | Agent | 25 LYNDENHURST LN, PALM COAST,, FL, 32137 |
| Name | Role | Address |
|---|---|---|
| Rowell LATASHA D | President | 25 LYNDENHURST LN, PALM COAST, FL, 32137 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-01-25 | Rowell, LATASHA D | No data |
| REINSTATEMENT | 2022-09-28 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-25 |
| REINSTATEMENT | 2022-09-28 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-06-07 |
| Domestic Profit | 2019-11-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
