| Entity Name: | ST. THOMAS MANOR, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 20 Nov 1996 (28 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | P96000096000 |
| FEI/EIN Number | 65-0710130 |
| Address: | 1110 S.W. 40TH AVENUE, PLANTATION, FL 33317 |
| Mail Address: | 1110 S.W. 40TH AVENUE, PLANTATION, FL 33317 |
| ZIP code: | 33317 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023269875 | 2008-10-09 | 2008-10-09 | 1110 SW 40TH AVE, PLANTATION, FL, 333174527, US | 1110 SW 40TH AVE, PLANTATION, FL, 333174527, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 954-583-3321 |
Authorized person
| Name | MR. MATHEW JACOB |
| Role | PRESIDENT/OWNER |
| Phone | 9545833321 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL1063 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140824100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JACOB, MATHEW | Agent | 1110 S.W. 40TH AVENUE, PLANTATION, FL 33317 |
| Name | Role | Address |
|---|---|---|
| JACOB, MATHEW | Director | 1110 SW 40TH AVENUE, PLANTATION, FL 33317 |
| JACOB, MARYKUTTY | Director | 1110 SW 40TH AVENUE, PLANTATION, FL 33317 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-19 |
| ANNUAL REPORT | 2012-04-10 |
| ANNUAL REPORT | 2011-04-25 |
| ANNUAL REPORT | 2010-04-08 |
| ANNUAL REPORT | 2009-04-22 |
| ANNUAL REPORT | 2008-03-25 |
| ANNUAL REPORT | 2007-03-12 |
| ANNUAL REPORT | 2006-01-31 |
| ANNUAL REPORT | 2005-04-08 |
| ANNUAL REPORT | 2004-04-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
