| Entity Name: | ORANGE PARK EXTENDED CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 17 Mar 2003 (22 years ago) |
| Date of dissolution: | 24 Sep 2021 (3 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 24 Sep 2021 (3 years ago) |
| Document Number: | L03000009509 |
| FEI/EIN Number | 20-0739986 |
| Address: | 480 Fentress Blvd., Suite H, Daytona beach, FL 32114 |
| Mail Address: | 480 Fentress Blvd., Suite H, Daytona beach, FL 32114 |
| ZIP code: | 32114 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205805421 | 2006-03-17 | 2012-06-12 | 1125 FLEMING PLANTATION BLVD, FLEMING ISLAND, FL, 320033389, US | 1125 FLEMING PLANTATION BLVD, ORANGE PARK, FL, 320033389, US | |||||||||||||||||||||||||||
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| Phone | +1 904-541-3500 |
| Fax | 9042138338 |
| Phone | +1 904-245-7620 |
Authorized person
| Name | MS. DONNA J. MARSH |
| Role | BOOKKEEPER |
| Phone | 3862551054 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | 130471035 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 028478500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Bengio, Jacob | Agent | 390 NE 135th Street Miami, FL 33161, Miami, FL 33161 |
| Name | Role |
|---|---|
| DVAR TOVE, LLC | Manager |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-03-25 | 390 NE 135th Street Miami, FL 33161, Miami, FL 33161 | No data |
| CHANGE OF MAILING ADDRESS | 2017-03-21 | 480 Fentress Blvd., Suite H, Daytona beach, FL 32114 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-03-21 | Bengio, Jacob | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-02-16 | 480 Fentress Blvd., Suite H, Daytona beach, FL 32114 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-29 |
| ANNUAL REPORT | 2017-03-21 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-02-16 |
| ANNUAL REPORT | 2014-04-20 |
| ANNUAL REPORT | 2013-03-20 |
| ANNUAL REPORT | 2012-04-09 |
| ANNUAL REPORT | 2011-04-18 |
Date of last update: 30 Jan 2025
Sources: Florida Department of State
