| Entity Name: | ISLF-DEERWOOD PLACE-JACKSONVILLE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Apr 2004 (21 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Feb 2016 (9 years ago) |
| Document Number: | L04000026301 |
| FEI/EIN Number | 20-0983025 |
| Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| Mail Address: | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL, 33401, US |
| ZIP code: | 33401 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1184039232 | 2014-06-27 | 2014-06-27 | 8700 A C SKINNER PKWY, JACKSONVILLE, FL, 322560836, US | 8700 A C SKINNER PKWY, JACKSONVILLE, FL, 322560836, US | |||||||||||||||||||||||
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| Phone | +1 904-642-7300 |
Authorized person
| Name | HOWARD JAFFE |
| Role | DIRECTOR |
| Phone | 2153466454 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | 6007 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 010730600 |
| State | FL |
| Name | Role |
|---|---|
| C T CORPORATION SYSTEM | Agent |
| Name | Role | Address |
|---|---|---|
| Jaffe Howard | Manager | 1665 Palm Beach Lakes Blvd., West Palm Beach, FL, 33401 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G16000050403 | REGENTS PARK OF JACKSONVILLE | ACTIVE | 2016-05-19 | 2026-12-31 | No data | 1665 PALM BEACH LAKES BLVD., SUITE 400, WEST PALM BEACH, FL, 33401 |
| G16000048414 | DEERWOOD PLACE | ACTIVE | 2016-05-13 | 2026-12-31 | No data | 1665 PALM BEACH LAKES BLVD., SUITE 400, WEST PALM BEACH, FL, 33401 |
| G10000039012 | DEERWOOD PLACE | EXPIRED | 2010-05-26 | 2015-12-31 | No data | 8700 A.C. SKIPPER PARKWAY, JACKSONVILLE, FL, 32256, US |
| G10000039014 | REGENTS PARK OF JACKSONVILLE | EXPIRED | 2010-05-05 | 2015-12-31 | No data | 8700 AC SKINNER PARKWAY, JACKSONVILLE, FL, 33256 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-04 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-04 | 1665 Palm Beach Lakes Blvd., Suite 400, West Palm Beach, FL 33401 | No data |
| LC STMNT OF RA/RO CHG | 2016-02-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-02-22 | C T CORPORATION SYSTEM | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-02-22 | 1200 SOUTH PINE ISLAND RD., SUITE 1550, PLANTATION, FL 33324 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-04 |
| ANNUAL REPORT | 2023-02-27 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-04-13 |
| ANNUAL REPORT | 2020-04-24 |
| ANNUAL REPORT | 2019-03-30 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-04-13 |
| ANNUAL REPORT | 2016-04-29 |
| CORLCRACHG | 2016-02-22 |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 345831770 | 0419700 | 2022-03-14 | 8700 A C SKINNER PKWY, JACKSONVILLE, FL, 32256 | |||||||||||||||||||||
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| Type | Referral |
| Activity Nr | 1706860 |
| Health | Yes |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
