| Entity Name: | SCG GRACEWOOD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 03 Jun 2005 (20 years ago) |
| Date of dissolution: | 22 Mar 2022 (3 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 22 Mar 2022 (3 years ago) |
| Document Number: | L05000055153 |
| FEI/EIN Number | 20-2971168 |
| Address: | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 |
| Mail Address: | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 |
| ZIP code: | 33619 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255333290 | 2005-08-10 | 2015-01-12 | 1240 MARBELLA PLAZA DR, TAMPA, FL, 336197906, US | 8600 US HIGHWAY 19 N, PINELLAS PARK, FL, 33782, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 813-341-2700 |
| Fax | 8133412755 |
| Phone | +1 727-541-7515 |
| Fax | 7275459473 |
Authorized person
| Name | MR. KEVIN GOYER |
| Role | PRESIDENT |
| Phone | 8133412700 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | NH4155 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 031664400 |
| State | FL |
| Issuer | BLUE CROSS AND BLUE SHIELD |
| Number | L85 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Vaughan, Michelle | Agent | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 |
| Name | Role | Address |
|---|---|---|
| SENIOR CARE GROUP, INC. | Manager | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2022-03-22 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2019-09-27 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-04-30 | Vaughan, Michelle | No data |
| REINSTATEMENT | 2016-11-11 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| REINSTATEMENT | 2015-10-01 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2007-03-29 | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2007-03-29 | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-03-29 | 1240 MARBELLA PLAZA DRIVE, TAMPA, FL 33619 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2022-03-22 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-05-01 |
| REINSTATEMENT | 2016-11-11 |
| REINSTATEMENT | 2015-10-01 |
| ANNUAL REPORT | 2014-04-08 |
| ANNUAL REPORT | 2013-04-10 |
| ANNUAL REPORT | 2012-02-02 |
| ANNUAL REPORT | 2011-01-04 |
| ANNUAL REPORT | 2010-01-06 |
Date of last update: 28 Jan 2025
Sources: Florida Department of State
