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BEAVER DAM HEALTH CARE MANOR, INC.

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Company Details

Name: BEAVER DAM HEALTH CARE MANOR, INC.
Legal type: Kentucky Corporation
Status: Inactive
Standing: Bad
Profit or Non-Profit: Non-profit
File Date: 09 Aug 1996 (29 years ago)
Organization Date: 09 Aug 1996 (29 years ago)
Last Annual Report: 15 Feb 2008 (17 years ago)
Organization Number: 0419859
Principal Office: 602 COURTLAND ST, SUITE 200, ORLANDO, FL 32804
Place of Formation: KENTUCKY

Treasurer

Name Role
BERNARD ELLIOT Treasurer

Secretary

Name Role
WALLACE COE Secretary

Chairman

Name Role
WILLIAM JONES Chairman

Director

Name Role
HUBERT MOOG Director
ROBERT MURPHY Director
RELIOUS WALDEN Director
HENRY J. CARUBBA Director
J DERYL KNUTSON Director
TIM HOATSON Director
JOHN BULLOCK Director
HOMER GROVE Director

Signature

Name Role
WILLIAM JONES Signature
Vann Camp Signature

Incorporator

Name Role
J DARIN STEWART Incorporator

President

Name Role
VANN CAMP President

Registered Agent

Name Role
CARMEN YOUNG Registered Agent

National Provider Identifier

NPI Number:
1538321781

Authorized Person:

Name:
MR. DAVID RODMAN
Role:
ASST SECRETARY
Phone:

Taxonomy:

Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4079753090
Fax:
2702749646

Assumed Names

Name Status Expiration Date
BEAVER DAM HEALTH CARE MANOR Inactive 2008-07-15

Filings

Name File Date
Administrative Dissolution 2009-11-03
Annual Report 2008-02-15
Annual Report 2007-04-02
Annual Report 2006-09-25
Statement of Change 2005-06-24

OSHA's Inspections within Industry

Inspection Summary

Date:
2005-06-27
Type:
Planned
Address:
1595 US HWY 231 S, BEAVER DAM, KY, 42320
Safety Health:
Safety
Scope:
Partial

Inspection Summary

Date:
2004-03-16
Type:
Planned
Address:
1595 US HWY 231 S, BEAVER DAM, KY, 42320
Safety Health:
Health
Scope:
Complete

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Sources: Kentucky Secretary of State