Provider Profile
EVELYN'S PLACE, INC.
Assisted Living Facility
FACILITY PROFILE
Street Address
- 4901 JEFFERSON STREET
HOLLYWOOD, FL 33021
County: Broward - Phone: (754) 204-6112
Mailing Address
- 4901 JEFFERSON STREET
HOLLYWOOD, FL 33021
County: Broward - Phone: (754) 204-6112
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Facility Information:
| Facility/Provider Type: | Assisted Living Facility | ||||||
| Administrator: | PRISCILLA KARESA WALTERS | ||||||
| Financial Officer: | PRISCILLA KARESA WALTERS | ||||||
| Owner/Licensee: | EVELYN'S PLACE, INC. | ||||||
| Owner/Licensee Since: | 3/7/2014 | ||||||
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| Profit Status: | For-Profit | ||||||
| Management Company: | Not Available | ||||||
| Manager Since: | Not Available | ||||||
| Licensed Beds: | 6 | ||||||
| Bed Types: | Extended Congregate Care: 0 Total Capacity: 6 Private: 6 Optional State Supplement: 0 | ||||||
| AHCA Number (File Number): | 11968633 | ||||||
| AHCA Field Office: | 10 | ||||||
| License Number: | 12519 | ||||||
| Current License Effective: | 9/8/2022 | ||||||
| Current License Expires: | 9/7/2024 | ||||||
| License Status: | IN REVIEW | ||||||
Services/Characteristics
| Medicaid Services: | Assistive Care Services |
| Activities: | Arts and CraftsGames/CardsMusic Programs |
| Bed Hold Policy: | Facility will hold beds during a temporary absence |
| Adult Day Care Services: | Yes |
| Continuing Care Retirement Community: | No |
| Languages Spoken: | English |
| Nurse Availability: | None |
| Payment Forms Accepted: | MedicaidOther |
| Community Residential Home | Yes |
Please be advised that local zoning authorities may have additional restrictions or requirements not under the jurisdiction of the Agency for Health Care Administration. Contact your local zoning authorities for any specific requirements. See also 419.001 F.S.
Emergency Power Plan Summary
| Onsite Alternate Power Source: | Portable Generator |
| Emergency Power Supports: | Entire Facility |
| Plan Approval: | 5/5/2020 |
| Implementation Date: | 1/18/2018 |
| Cooling Method: | Air ConditionerFansSpot Coolers |
| Areas Cooled: | Entire Facility |
| Areas Cooled Location: | Within Facility |
| Square Footage Cooled: | 900 |
| Number of People to use Cooled Space: | 8 |
Legal Actions
| Date Initiated | Case # | Case Type | Violation | Fine Amount | Date Imposed |
|---|---|---|---|---|---|
| 6/5/2020 | 2020009973 | Fine | Survey | $4,000.00 | 10/20/2020 |
Important information and facility/provider definitions can be found in the Glossary.
Attn Providers: Requests for changes in data must be sent in writing to the AHCA licensing office.