| Entity Name: | ABBIEJEAN RUSSELL CARE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 18 Mar 2003 (22 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | L03000009831 |
| FEI/EIN Number | NOT APPLICABLE |
| Address: | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL, 33179, US |
| Mail Address: | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL, 33179, US |
| ZIP code: | 33179 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1770595738 | 2006-08-11 | 2012-07-31 | 700 S 29TH ST, FORT PIERCE, FL, 349473626, US | 700 S 29TH ST, FORT PIERCE, FL, 349473626, US | |||||||||||||||||||||||||||||||
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| Phone | +1 772-465-7560 |
| Fax | 7724655619 |
Authorized person
| Name | MARIA ELVA GONZALEZ |
| Role | OWNER |
| Phone | 7863854364 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF10020961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026875500 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | M4K |
| State | FL |
| Name | Role | Address |
|---|---|---|
| JEROSLOW LOUISE T | Agent | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL, 33179 |
| Name | Role | Address |
|---|---|---|
| Fannin Deborah | Manager | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL, 33179 |
| Gonzalez Maria E | Manager | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-03-30 | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL 33179 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-20 | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL 33179 | No data |
| CHANGE OF MAILING ADDRESS | 2021-04-20 | 1835 ne Miami Gardens Dr 167, North Miami Beach, FL 33179 | No data |
| LC STMNT OF AUTHORITY | 2014-08-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2006-03-22 | JEROSLOW, LOUISE T | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2022-10-18 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-25 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-04-05 |
| ANNUAL REPORT | 2015-04-06 |
| CORLCAUTH | 2014-08-22 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
