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CREEKWOOD PLACE NURSING & REHAB CENTER, INC.

Company Details

Name: CREEKWOOD PLACE NURSING & REHAB CENTER, INC.
Legal type: Kentucky Corporation
Status: Inactive
Standing: Good
Profit or Non-Profit: Non-profit
File Date: 08 Nov 2006 (19 years ago)
Organization Date: 08 Nov 2006 (19 years ago)
Last Annual Report: 23 Jun 2021 (4 years ago)
Organization Number: 0650532
Principal Office: 485 N. KELLER ROAD, SUITE 250, MAITLAND, FL 32751
Place of Formation: KENTUCKY

President

Name Role
Keith Boyce President

Assistant Secretary

Name Role
MARK BLOCK Assistant Secretary
Lynn Addiscott Assistant Secretary
David Rodman Assistant Secretary
Michael Saunders Assistant Secretary
Jeff Graff Assistant Secretary
Paul Rathbun Assistant Secretary
Nigel Hinds Assistant Secretary
Thomas Evans Assistant Secretary

Director

Name Role
Keith Boyce Director
Timothy Beaulieu Director
Michael Thompson Director
Anita Young Director
Thomas Evans Director
Nigel Hinds Director
Lisa Musgrave Director
Sandra K Johnson Director
G. THOMAS EVANS Director
MICHELLE FETTERS Director

Chairman

Name Role
Sandra K Johnson Chairman

Incorporator

Name Role
T. L. TRIMBLE Incorporator

Registered Agent

Name Role
C T CORPORATION SYSTEM Registered Agent

National Provider Identifier

NPI Number:
1619982410

Authorized Person:

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

Taxonomy:

Selected Taxonomy:
332B00000X - Durable Medical Equipment & Medical Supplies
Is Primary:
No
Selected Taxonomy:
314000000X - Skilled Nursing Facility
Is Primary:
Yes

Contacts:

Fax:
4079753090
Fax:
2707268706

Filings

Name File Date
Dissolution 2022-01-26
Annual Report 2021-06-23
Principal Office Address Change 2020-06-23
Annual Report 2020-06-23
Annual Report 2019-06-25

Motor Carrier Census

Carrier Operation:
Intrastate Non-Hazmat
Fax:
(270) 726-8706
Add Date:
2009-01-23
Operation Classification:
Priv. Pass. (Business)
power Units:
1
Drivers:
10
Inspections:
0
FMCSA Link:

Sources: Kentucky Secretary of State