| Entity Name: | SENIOR HEALTH - WINTER HAVEN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Nov 2000 (24 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Feb 2016 (9 years ago) |
| Document Number: | L00000014723 |
| FEI/EIN Number | 36-4403590 |
| Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| Mail Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1558365270 | 2005-06-10 | 2012-10-05 | 1675 PALM BEACH LAKES BLVD, SUITE 900, WEST PALM NEACH, FL, 33401, US | 202 AVENUE O NE, WINTER HAVEN, FL, 338812409, US | |||||||||||||||||||||||||||||
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| Phone | +1 561-801-7600 |
| Fax | 4142684811 |
| Phone | +1 863-293-3103 |
| Fax | 8632945767 |
Authorized person
| Name | HOWARD JAFFE |
| Role | PRESIDENT |
| Phone | 2153466454 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1185096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 022870200 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Jaffe Howard | Manager | 1665 Palm Beach Lakes Blvd., West Palm Beach, FL, 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000050564 | WINTER HAVEN HEALTH AND REHABILITATION CENTER | ACTIVE | 2016-05-19 | 2026-12-31 | No data | 202 AVENUE O NORTH EAST, WINTER HAVEN, FL, 33881 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-29 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-29 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| LC STMNT OF RA/RO CHG | 2016-02-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-22 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-22 | 1200 SOUTH PINE ISLAND ROAD, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-29 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-03-30 |
| AMENDED ANNUAL REPORT | 2021-06-15 |
| ANNUAL REPORT | 2021-04-05 |
| ANNUAL REPORT | 2020-04-24 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-13 |
| ANNUAL REPORT | 2016-04-30 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No data | IDV | VA248BO0146 | 2009-08-01 | No data | No data | |||||||||||||||||||||
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| Title | WINTER HAVEN NURSING HOME |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME CARE CONTRACTS |
Recipient Details
| Recipient | SENIOR HEALTH - WINTER HAVEN, LLC |
| UEI | NE3CV66N2UM5 |
| Legacy DUNS | 019261790 |
| Recipient Address | 202 AVENUE O NE, WINTER HAVEN, 338812409, UNITED STATES |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
