| Entity Name: | VISTA MANOR HEALTH CARE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Jul 2001 (23 years ago) |
| Document Number: | L01000012580 |
| FEI/EIN Number | 582639488 |
| Mail Address: | 303 PERIMETER CENTER NORTH, SUITE 500, ATLANTA, GA, 30346, US |
| Address: | 1550 JESS PARRISH COURT, TITUSVILLE, FL, 32796, US |
| ZIP code: | 32796 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1033165436 | 2006-05-26 | 2013-03-22 | 1550 JESS PARRISH CT, TITUSVILLE, FL, 327962147, US | 1550 JESS PARRISH CT, TITUSVILLE, FL, 327962147, US | |||||||||||||||||||||||||
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| Phone | +1 321-269-2200 |
| Fax | 3213834990 |
Authorized person
| Name | DEBRA A. WALLACE |
| Role | MANAGER |
| Phone | 3212692200 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1580096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025252200 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| CLINTON LAURY J | Manager | 1550 JESS PARRISH COURT, TITUSVILLE, FL, 32796 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2012-02-01 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L11000131352. MERGER NUMBER 700000119987 |
| AMENDED AND RESTATEDARTICLES | 2004-08-09 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2004-04-07 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
