| Entity Name: | POTTER'S HOUSE AT CANNON POINT, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 17 Jun 1998 (27 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P98000054856 |
| FEI/EIN Number | 650847437 |
| Address: | 5820 NW 27TH CT, LAUDERHILL, FL, 33313, US |
| Mail Address: | 5820 NW 27TH CT, LAUDERHILL, FL, 33313, US |
| ZIP code: | 33313 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477064095 | 2017-10-23 | 2017-10-23 | 5820 5830 NW 27TH CT, LAUDERHILL, FL, 333132330, US | 5820 5830 NW 27TH CT, LAUDERHILL, FL, 333132330, US | |||||||||||||||||||||||||
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| Phone | +1 954-733-3366 |
| Fax | 9547332993 |
Authorized person
| Name | PATRICIA BUCHANAN |
| Role | ADMINISTRATOR |
| Phone | 9547333366 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL10434 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002314100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HOLDER HEATHER | Agent | 5820 NW 27TH CT., LAUDERHILL, FL, 33313 |
| Name | Role | Address |
|---|---|---|
| HOLDER HEATHER | President | 5820 NW 27 COURT, LAUDERHILL, FL, 33313 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| AMENDMENT | 2019-09-16 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2019-09-16 | HOLDER, HEATHER | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2005-04-12 | 5820 NW 27TH CT, LAUDERHILL, FL 33313 | No data |
| CHANGE OF MAILING ADDRESS | 2005-04-12 | 5820 NW 27TH CT, LAUDERHILL, FL 33313 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-12 | 5820 NW 27TH CT., LAUDERHILL, FL 33313 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J05900009358 | LAPSED | 03-1433S (21) | 17TH JUD CR IN AND FOR BROWARD | 2005-05-13 | 2010-05-24 | $54258.72 | PRAMCO CV6, LLC, 230 CROSSKEYS OFFICE PARK, FAIRPORT, NY 14450 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-04-27 |
| ANNUAL REPORT | 2021-01-29 |
| ANNUAL REPORT | 2020-03-13 |
| Amendment | 2019-09-16 |
| ANNUAL REPORT | 2019-01-25 |
| ANNUAL REPORT | 2018-01-16 |
| ANNUAL REPORT | 2017-02-16 |
| ANNUAL REPORT | 2016-03-18 |
| ANNUAL REPORT | 2015-03-03 |
| ANNUAL REPORT | 2014-01-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
