| Entity Name: | FAIRWAY OAKS CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 19 Dec 2002 (22 years ago) |
| Last Event: | LC AMENDMENT |
| Event Date Filed: | 25 Nov 2024 (2 months ago) |
| Document Number: | L02000034237 |
| FEI/EIN Number | 431988446 |
| Address: | 885 THIRD AVENUE, 29TH FLOOR, NEW YORK, NY, 10022, US |
| Mail Address: | 885 THIRD AVENUE, 29TH FLOOR, NEW YORK, NY, 10022, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285622209 | 2005-10-13 | 2024-06-12 | 13806 N 46TH ST, TAMPA, FL, 336134921, US | 13806 N 46TH ST, TAMPA, FL, 336134921, US | |||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 813-977-4214 |
| Fax | 8139774228 |
Authorized person
| Name | MRS. JENNIFER ALISE ZIOLKOWSKI |
| Role | VP FINANCE |
| Phone | 8135586629 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1613096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026069000 |
| State | FL |
| Issuer | EVERCARE HH CONNECTION |
| Number | 71-00465 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | M85 |
| State | FL |
| Issuer | UNITED AMERICAN |
| Number | C105305 |
| State | FL |
| Name | Role |
|---|---|
| PLATINUM AGENT SERVICES LLC | Agent |
| Name | Role |
|---|---|
| FAIRWAY OAKS HOLDCO, LLC | Managing Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000051390 | FAIRWAY OAKS CENTER | ACTIVE | 2024-04-17 | 2029-12-31 | No data | 885 THIRD AVENUE 29TH FLOOR, NEW YORK, NY, 10022 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC AMENDMENT | 2024-11-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2024-11-25 | 885 THIRD AVENUE, 29TH FLOOR, NEW YORK, NY 10022 | No data |
| CHANGE OF MAILING ADDRESS | 2024-11-25 | 885 THIRD AVENUE, 29TH FLOOR, NEW YORK, NY 10022 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-06-26 | Platinum Agent Services LLC | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-06-26 | 155 Office Plaza Dr, Tallahassee, FL 32301 | No data |
| LC AMENDMENT | 2021-01-29 | No data | No data |
| Name | Date |
|---|---|
| LC Amendment | 2024-11-25 |
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-06-26 |
| ANNUAL REPORT | 2022-07-14 |
| ANNUAL REPORT | 2021-07-28 |
| LC Amendment | 2021-01-29 |
| ANNUAL REPORT | 2020-04-01 |
| ANNUAL REPORT | 2019-03-15 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-03-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
