| Entity Name: | EMERALD SHORES HEALTH CARE ASSOCIATES, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 30 Jul 2001 (23 years ago) |
| Document Number: | L01000012611 |
| FEI/EIN Number | 582639436 |
| Mail Address: | 303 PERIMETER CENTER NORTH, SUITE 500, ATLANTA, GA, 30346, US |
| Address: | 626 NORTH TYNDALL PARKWAY, CALLAWAY, FL, 32404, US |
| ZIP code: | 32404 |
| County: | Bay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023093804 | 2005-12-14 | 2013-11-19 | 626 N TYNDALL PKWY, CALLAWAY, FL, 324046132, US | 626 N TYNDALL PKWY, CALLAWAY, FL, 324046132, US | |||||||||||||||||||||||||
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| Phone | +1 850-871-6363 |
| Fax | 8508716367 |
Authorized person
| Name | JEFFREY C. MARK |
| Role | MANAGER |
| Phone | 8508716363 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1292096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025219100 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| HENNINGS MARGARET M | Manager | 626 NORTH TYNDALL PARKWAY, CALLAWAY, FL, 32404 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| MERGER | 2012-02-01 | No data | CORPORATION WAS PART OF A MERGER. QUALIFIED CORPORATION WAS L11000131238. MERGER NUMBER 100000119971 |
| AMENDED AND RESTATEDARTICLES | 2004-08-09 | No data | No data |
| AMENDED AND RESTATEDARTICLES | 2004-04-01 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
