| Entity Name: | SAN CAYETANO HOME INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 30 Sep 1996 (28 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 17 Dec 2004 (20 years ago) |
| Document Number: | P96000081524 |
| FEI/EIN Number | 650709636 |
| Address: | 3525 S.W. 104TH COURT, MIAMI, FL, 33165 |
| Mail Address: | 3525 S.W. 104TH COURT, MIAMI, FL, 33165 |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396940896 | 2007-06-15 | 2008-08-29 | 3525 SW 104TH CT, MIAMI, FL, 331653717, US | 3525 SW 104TH CT, MIAMI, FL, 331653717, US | |||||||||||||||||||||||
|
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| Phone | +1 305-221-7733 |
Authorized person
| Name | MRS. GLIDYS PENA |
| Role | PRESIDENT |
| Phone | 3052217733 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL8859 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140753800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PENA GLIDYS | Agent | 3525 S.W. 104TH COURT, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| PENA GLIDYS | President | 3525 NW 104 CT., MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| MEDINA SIVIA | Vice President | 1118 NW 136 ST, MIAMI, FL, 33182 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT | 2004-12-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2004-12-17 | PENA, GLIDYS | No data |
| REINSTATEMENT | 1999-06-14 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1997-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-11 |
| ANNUAL REPORT | 2023-04-03 |
| ANNUAL REPORT | 2022-04-25 |
| ANNUAL REPORT | 2021-04-14 |
| ANNUAL REPORT | 2020-05-15 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-27 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-03-02 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
