| Entity Name: | CCHI, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 17 May 2005 (20 years ago) |
| Date of dissolution: | 06 Nov 2020 (4 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 06 Nov 2020 (4 years ago) |
| Document Number: | L05000048848 |
| FEI/EIN Number | 20-2866234 |
| Address: | 400 Second Ave NW, HICKORY, NC 28601-6123 |
| Mail Address: | PO BOX 2568, HICKORY, NC 28603-2568 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174519300 | 2005-09-22 | 2008-06-25 | 583 NE 351 HWY, CROSS CITY, FL, 326283108, US | 583 NE 351 HWY, CROSS CITY, FL, 326283108, US | |||||||||||||||||||||||||||||||
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| Phone | +1 352-498-2005 |
| Fax | 3524982006 |
Authorized person
| Name | MRS. DONITA TANNENBAUM |
| Role | ADMINISTRATOR |
| Phone | 3524982005 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF130470998 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | STATE FACILITY MDS ID NUM |
| Number | 35960937 |
| State | FL |
| Issuer | MEDICAID |
| Number | 031215100 |
| State | FL |
| Name | Role |
|---|---|
| INCORP SERVICES, INC. | Agent |
| Name | Role | Address |
|---|---|---|
| TREFZGER, CHARLES EJR. | Managing Member | 400 Second Ave NW, HICKORY, NC 28601-6123 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2023-03-17 | 3458 LAKESHORE DRIVE, TALLAHASSEE, FL 32312 | No data |
| REINSTATEMENT | 2020-11-06 | No data | No data |
| VOLUNTARY DISSOLUTION | 2020-11-06 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2020-11-06 | INCORP SERVICES INC | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2020-09-25 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-25 | 400 Second Ave NW, HICKORY, NC 28601-6123 | No data |
| LC STMNT OF RA/RO CHG | 2016-05-13 | No data | No data |
| LC AMENDMENT | 2010-12-21 | No data | No data |
| LC AMENDMENT | 2008-11-05 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2008-11-05 | 400 Second Ave NW, HICKORY, NC 28601-6123 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-11-06 |
| REINSTATEMENT | 2020-11-06 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-03-20 |
| ANNUAL REPORT | 2017-03-25 |
| CORLCRACHG | 2016-05-13 |
| ANNUAL REPORT | 2016-04-14 |
| ANNUAL REPORT | 2015-03-23 |
| ANNUAL REPORT | 2014-04-04 |
| ANNUAL REPORT | 2013-04-10 |
Date of last update: 29 Jan 2025
Sources: Florida Department of State
