| Entity Name: | LAKE CITY MGT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Mar 2003 (22 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 29 Jan 2016 (9 years ago) |
| Document Number: | L03000010664 |
| FEI/EIN Number | 050560677 |
| Mail Address: | PO Box 530787, DEBARY, FL, 32753, US |
| Address: | 1207 S.W. Main Street, Suite 1-E, Lake City, FL, 32025, US |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750365706 | 2005-12-02 | 2020-10-08 | 1270 SW MAIN BLVD, LAKE CITY, FL, 320256684, US | 1270 SW MAIN BLVD, LAKE CITY, FL, 320256684, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-752-7900 |
| Fax | 3867528556 |
Authorized person
| Name | MR. LAVERN PATRICK HERZOG |
| Role | PRESIDENT |
| Phone | 3869566956 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF15510961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 026162900 |
| State | FL |
| Name | Role |
|---|---|
| COGENCY GLOBAL INC. | Agent |
| Name | Role | Address |
|---|---|---|
| HERZOG L P | Manager | PO Box 530787, DEBARY, FL, 32753 |
| SWAIN W S | Manager | PO Box 71030, Myrtle Beach, SC, 29572 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09000104074 | AVALON HEALTHCARE CENTER | EXPIRED | 2009-05-05 | 2024-12-31 | No data | 1270 SW MAIN BOULEVARD, LAKE CITY, FL, 32055 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2024-04-19 | 1207 S.W. Main Street, Suite 1-E, Lake City, FL 32025 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2017-04-24 | 115 North Calhoun Street, Suite 4, Tallahassee, FL 32301 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-29 | 1207 S.W. Main Street, Suite 1-E, Lake City, FL 32025 | No data |
| LC STMNT OF RA/RO CHG | 2016-01-29 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-01-29 | COGENCY GLOBAL INC. | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J21000566269 | ACTIVE | 18001114CCAXMX | COLUMBIA COUNTY COURT CLERK | 2021-07-16 | 2026-11-10 | $8,465.26 | EMORY MEDICAL CORPORATION DBA WOMEN'S CENTER OF FLORIDA, 4812 W. US HWY 90 SUITE A, LAKE CITY FL, 32055 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-19 |
| ANNUAL REPORT | 2023-04-11 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-09 |
| ANNUAL REPORT | 2019-04-09 |
| ANNUAL REPORT | 2018-04-18 |
| ANNUAL REPORT | 2017-04-24 |
| ANNUAL REPORT | 2016-04-29 |
| CORLCRACHG | 2016-01-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
