| Entity Name: | DONEGAN SQUARE HEALTH CARE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 30 Jul 2001 (23 years ago) |
| Document Number: | L01000012607 |
| FEI/EIN Number | 582639494 |
| Address: | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL, 32751, US |
| Mail Address: | 1040 CROWN POINTE PKWY STE 600, ATLANTA, GA, 30338-4741, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548207459 | 2006-05-31 | 2020-04-29 | 1092 W DONEGAN AVE, KISSIMMEE, FL, 347412218, US | 1092 W DONEGAN AVE, KISSIMMEE, FL, 347412218, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-846-8520 |
| Fax | 4079444808 |
Authorized person
| Name | KENNETH USSERY |
| Role | VP |
| Phone | 4075711550 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL5527 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 141700200 |
| State | FL |
| Issuer | MEDICAID |
| Number | 683884700 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| EPSILON HEALTH CARE PROPERTIES, LLC | Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000090115 | KEYSTONE VILLAS ASSISTED LIVING CENTER | ACTIVE | 2013-09-11 | 2028-12-31 | No data | 1040 CROWN POINTE PARKWAY, SUITE 600, ATLANTA, GA, 30338 |
| G09000141835 | KEYSTONE VILLAS | EXPIRED | 2009-08-03 | 2014-12-31 | No data | 1092 WEST DONEGAN AVENUE, KISSIMMEE, FL, 34741 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDED AND RESTATEDARTICLES | 2004-08-09 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2004-04-01 | No data | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
