| Entity Name: | PHOENIX HEALTHCARE PROPERTIES OF MANDARIN, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 11 Aug 2004 (20 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: | L04000059542 |
| FEI/EIN Number | 202694743 |
| Mail Address: | 199 N. E. 89 STREET, EL PORTAL, FL, 33138 |
| Address: | 199 N. E. 89 Street, El Portal, FL, 33138, US |
| ZIP code: | 33138 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538192208 | 2006-07-08 | 2009-12-01 | 199 NE 89TH STREET, EL PORTAL, FL, 331383010, US | 10680 SAINT AUGUSTINE ROAD, JACKSONVILLE, FL, 322571000, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-759-4046 |
| Fax | 3057594056 |
| Phone | +1 904-268-4953 |
Authorized person
| Name | MR. DION R. SENA |
| Role | MANAGING MEMBER |
| Phone | 3057594046 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF13060961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031237100 |
| State | FL |
| Issuer | BLUE CROSS INSURANCE |
| Number | L69 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEWIS PETER A | Agent | 3023 N Shannon Lakes Dr, TALLAHASSEE, FL, 32309 |
| Name | Role | Address |
|---|---|---|
| SENA DION R | Managing Member | 199 N. E. 89 STREET, EL PORTAL, FL, 33138 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G13000001477 | SOUTHLAKE NURSING & REHABILITATION CENTER | EXPIRED | 2013-01-04 | 2018-12-31 | No data | 10680 OLD ST. AUGUSTINE ROAD, JACKSONVILLE, FL, 32257 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-03-23 | 199 N. E. 89 Street, El Portal, FL 33138 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-03-27 | 3023 N Shannon Lakes Dr, Suite 101, TALLAHASSEE, FL 32309 | No data |
| CHANGE OF MAILING ADDRESS | 2007-04-09 | 199 N. E. 89 Street, El Portal, FL 33138 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2020-02-26 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-02 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-04-07 |
| ANNUAL REPORT | 2015-03-23 |
| ANNUAL REPORT | 2014-03-27 |
| ANNUAL REPORT | 2013-03-18 |
| ANNUAL REPORT | 2012-01-31 |
| ANNUAL REPORT | 2011-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
