| Entity Name: | KISSIMMEE 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: | L01000012568 |
| FEI/EIN Number | 582639452 |
| Mail Address: | 303 PERIMETER CENTER NORTH, SUITE 500, ATLANTA, GA, 30346, US |
| Address: | 1120 WEST DONEGAN AVENUE, KISSIMMEE, FL, 34741, US |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1427003763 | 2006-05-24 | 2012-09-27 | 1120 W DONEGAN AVE, KISSIMMEE, FL, 347412247, US | 1120 W DONEGAN AVE, KISSIMMEE, FL, 347412247, US | |||||||||||||||||||||||||
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| Phone | +1 407-847-2854 |
| Fax | 4079944184 |
Authorized person
| Name | TYRUS D. HAWKINS |
| Role | MANAGER |
| Phone | 4078472854 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 130471039 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031756000 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| ALICEA JOSE D | Manager | 1120 WEST DONEGAN AVENUE, KISSIMMEE, FL, 34741 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000082974 | LAKESIDE OAKS CARE CENTER | EXPIRED | 2011-08-22 | 2016-12-31 | No data | 1061 VIRGINIA STREET, DUNEDIN, FL, 34698-7326 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2012-02-01 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L11000131287. MERGER NUMBER 300000119913 |
| CHANGE OF PRINCIPAL ADDRESS | 2011-04-22 | 1120 WEST DONEGAN AVENUE, KISSIMMEE, FL 34741 | No data |
| CHANGE OF MAILING ADDRESS | 2011-04-22 | 1120 WEST DONEGAN AVENUE, KISSIMMEE, FL 34741 | No data |
| REGISTERED AGENT NAME CHANGED | 2005-04-12 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2005-04-12 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| AMENDED AND RESTATEDARTICLES | 2004-04-29 | No data | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J12000224801 | TERMINATED | 1000000253533 | OSCEOLA | 2012-03-13 | 2032-03-28 | $ 6,135.29 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, OUT OF STATE/CENTRAL COLLECTIONS UNIT, 5050 W TENNESSEE ST, TALLAHASSEE FL323996586 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2011-04-22 |
| ANNUAL REPORT | 2010-04-27 |
| ANNUAL REPORT | 2009-05-01 |
| ANNUAL REPORT | 2008-04-30 |
| ANNUAL REPORT | 2007-05-01 |
| ANNUAL REPORT | 2006-04-20 |
| ANNUAL REPORT | 2005-04-29 |
| Reg. Agent Change | 2005-04-12 |
| Amended and Restated Articles | 2004-04-29 |
| ANNUAL REPORT | 2004-04-20 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
