| Entity Name: | BEAUCLERC MANOR HEALTH CARE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Jul 2001 (24 years ago) |
| Date of dissolution: | 01 Feb 2012 (13 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 01 Feb 2012 (13 years ago) |
| Document Number: | L01000012547 |
| FEI/EIN Number | 582639423 |
| Mail Address: | 303 PERIMETER CENTER NORTH, SUITE 500, ATLANTA, GA, 30346, US |
| Address: | 9355 SAN JOSE BLVD., JACKSONVILLE, FL, 32257, US |
| ZIP code: | 32257 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134174451 | 2006-05-24 | 2013-05-26 | 9355 SAN JOSE BLVD, JACKSONVILLE, FL, 322575503, US | 9355 SAN JOSE BLVD, JACKSONVILLE, FL, 322575503, US | |||||||||||||||||||||||||
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| Phone | +1 904-739-0877 |
| Fax | 9044489253 |
Authorized person
| Name | GWENDOLYN S. GAMEL |
| Role | MANAGER |
| Phone | 9047390877 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1047096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025205100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| TOMACK JEFFREY H | Manager | 9355 SAN JOSE BLVD., JACKSONVILLE, FL, 32257 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000117909 | SAN JOSE HEALTH AND REHABILITATION CENTER | EXPIRED | 2009-06-11 | 2014-12-31 | No data | 9355 SAN JOSE BOULEVARD, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2012-02-01 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L11000131341. MERGER NUMBER 300000119903 |
| CHANGE OF MAILING ADDRESS | 2011-04-20 | 9355 SAN JOSE BLVD., JACKSONVILLE, FL 32257 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-11 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-11 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| AMENDED AND RESTATEDARTICLES | 2004-08-09 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-04-20 | 9355 SAN JOSE BLVD., JACKSONVILLE, FL 32257 | No data |
| AMENDED AND RESTATEDARTICLES | 2004-04-01 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-20 |
| ANNUAL REPORT | 2010-04-26 |
| ANNUAL REPORT | 2009-04-29 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-04-02 |
| ANNUAL REPORT | 2006-04-13 |
| ANNUAL REPORT | 2005-04-29 |
| Reg. Agent Change | 2005-04-11 |
| Amended and Restated Articles | 2004-08-09 |
| ANNUAL REPORT | 2004-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
