| Entity Name: | SUMMERVILLE AT PORT ORANGE, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Profit |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 04 May 1998 (27 years ago) |
| Date of dissolution: | 05 Nov 2020 (4 years ago) |
| Last Event: | WITHDRAWAL |
| Event Date Filed: | 05 Nov 2020 (4 years ago) |
| Document Number: | F98000002517 |
| FEI/EIN Number |
522103425
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Mail Address: | 111 WESTWOOD PLACE, SUITE 400, BRENTWOOD, TN, 37027 |
| Address: | 111 Westwood Place, Brentwood, TN, 37027, US |
| Place of Formation: | DELAWARE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750545158 | 2008-07-15 | 2016-05-13 | 6737 W WASHINGTON ST, SUITE 2300, MILWAUKEE, WI, 532145647, US | 1675 DUNLAWTON AVE, PORT ORANGE, FL, 321274755, US | |||||||||||||||||||||||||||||
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| Phone | +1 386-761-1055 |
| Fax | 3867614408 |
Authorized person
| Name | BRYAN RICHARDSON |
| Role | EVP, CHIEF ADMIN. OFFICER |
| Phone | 6155648131 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL9792 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 311500000X - Alzheimer Center (Dementia Center) |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 0111336-00 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Patchett Mary Sue | Executive Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Baier Lucinda M | Chief Executive Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| White Chad C | Executive Vice President | 111 Westwood Place, Brentwood, TN, 37027 |
| Leskowicz Joanne | Secretary | 6737 W. Washington, Milwaukee, WI, 53214 |
| Leskowicz Joanne | Vice President | 6737 W. Washington, Milwaukee, WI, 53214 |
| Swain Steven | Chief Financial Officer | 111 Westwood Place, Brentwood, TN, 37027 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000012844 | BROOKDALE YORKTOWNE | EXPIRED | 2015-02-04 | 2020-12-31 | - | 111 WESTWOOD PL STE 400, BRENTWOOD, TN, 37027 |
| G08149900378 | EMERITUS AT PORT ORANGE | EXPIRED | 2008-05-28 | 2013-12-31 | - | 3131 ELLIOTT AVENUE, SUITE 500, SEATTLE, WA, 98121 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT CHANGED | 2020-11-05 | REGISTERED AGENT REVOKED | - |
| WITHDRAWAL | 2020-11-05 | - | - |
| CHANGE OF MAILING ADDRESS | 2020-11-05 | 111 Westwood Place, Suite 400, Brentwood, TN 37027 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-27 | 111 Westwood Place, Suite 400, Brentwood, TN 37027 | - |
| REINSTATEMENT | 2004-12-22 | - | - |
| REVOKED FOR ANNUAL REPORT | 2004-10-01 | - | - |
| REINSTATEMENT | 2000-11-03 | - | - |
| REVOKED FOR ANNUAL REPORT | 2000-09-22 | - | - |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J13001804773 | TERMINATED | 1000000557059 | LEON | 2013-12-05 | 2033-12-26 | $ 7,667.01 | STATE OF FLORIDA0050380 |
| Name | Date |
|---|---|
| WITHDRAWAL | 2020-11-05 |
| ANNUAL REPORT | 2020-06-12 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-24 |
| ANNUAL REPORT | 2017-04-27 |
| ANNUAL REPORT | 2016-04-02 |
| ANNUAL REPORT | 2015-04-17 |
| ANNUAL REPORT | 2014-04-27 |
| ANNUAL REPORT | 2013-04-23 |
| ANNUAL REPORT | 2012-04-23 |
Date of last update: 02 Mar 2025
Sources: Florida Department of State
