| Entity Name: | SHADY OAKS LIVING CENTER, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Sep 1999 (25 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 01 Oct 2010 (14 years ago) |
| Document Number: | P99000085534 |
| FEI/EIN Number | 593599079 |
| Address: | 2208 E. 138 AVENUE, TAMPA, FL, 33613 |
| Mail Address: | P.O. Box 280155, TAMPA, FL, 33682-0155, US |
| ZIP code: | 33613 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699076703 | 2010-11-04 | 2010-11-04 | PO BOX 280339, TAMPA, FL, 336820339, US | 2208 E 138TH AVE, TAMPA, FL, 336134435, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 813-978-0819 |
| Fax | 8134256925 |
Authorized person
| Name | MR. JOSEPH WILFRED JOSEPH |
| Role | PRESIDENT/ADMINISTRATOR |
| Phone | 8139780819 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL 8450 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 3104A0625X - Assisted Living Facility (Mental Illness) |
| License Number | AL 8450 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 140792900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JOSEPH JOSEPH W | Agent | 2208 E. 138 AVENUE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| JOSEPH JOSEPH W | President | 2208 E. 138 AVENUE, TAMPA, FL, 33613 |
| Name | Role | Address |
|---|---|---|
| JOSEPH GEETHA | Vice President | 2208 E. 138 AVENUE, TAMPA, FL, 33613 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2016-01-23 | 2208 E. 138 AVENUE, TAMPA, FL 33613 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-01-24 | 2208 E. 138 AVENUE, TAMPA, FL 33613 | No data |
| REINSTATEMENT | 2010-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-03 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-29 |
| ANNUAL REPORT | 2021-02-04 |
| ANNUAL REPORT | 2020-01-17 |
| ANNUAL REPORT | 2019-02-10 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-01-23 |
| ANNUAL REPORT | 2015-01-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
