| Entity Name: | CARE CENTERS OF NASSAU, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 31 May 2007 (18 years ago) |
| Last Event: | LC STMNT OF RA/RO CHG |
| Event Date Filed: | 22 Aug 2023 (a year ago) |
| Document Number: | L07000057831 |
| FEI/EIN Number | 800243327 |
| Address: | 5243 Little Debbie Parkway, Ooltewah, TN, 37363, US |
| Mail Address: | 5243 Little Debbie Parkway, Ooltewah, TN, 37363, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659448306 | 2006-11-29 | 2009-10-09 | 95146 HENDRICKS RD, FERNANDINA BEACH, FL, 32034, US | 95146 HENDRICKS RD, FERNANDINA BEACH, FL, 32034, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 904-261-5518 |
| Fax | 9042615517 |
Authorized person
| Name | MS. SHARON JAMISON |
| Role | ADMINISTRATOR |
| Phone | 9042615518 |
Taxonomy
| Taxonomy Code | 315P00000X - Intellectual Disabilities Intermediate Care Facility |
| License Number | 4010096 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 315P00000X - Intellectual Disabilities Intermediate Care Facility |
| License Number | 40950955 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 315P00000X - Intellectual Disabilities Intermediate Care Facility |
| License Number | 40950956 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 315P00000X - Intellectual Disabilities Intermediate Care Facility |
| License Number | 028539100 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 028539100 |
| State | FL |
| Issuer | MEDICAID |
| Number | 028539196 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARE CENTERS OF NASSAU, LLC 403(B) PLAN | 2013 | 800243327 | 2014-12-01 | CARE CENTERS OF NASSAU, LLC | 42 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2014-12-01 |
| Name of individual signing | WILLIAM ROWE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role |
|---|---|
| REGISTERED AGENTS INC | Agent |
| Name | Role | Address |
|---|---|---|
| WALDROP MARK A | President | 5243 LITTLE DEBBIE PARKWAY, OOLTEWAH, TN, 373634515 |
| Name | Role | Address |
|---|---|---|
| Wagner Todd D | Vice President | 5243 Little Debbie Parkway, Ooltewah, TN, 37363 |
| Davis Phil | Vice President | 5243 Little Debbie Parkway, Ooltewah, TN, 37363 |
| Name | Role |
|---|---|
| NASSAU CARE CENTERS, INC. | Managing Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09083900206 | HENDRICKS | ACTIVE | 2009-03-24 | 2029-12-31 | No data | 1890 STATE ROAD 436, SUITE 300, WINTER PARK, FL, 32792 |
| G09083900201 | MINER SOUTH | ACTIVE | 2009-03-24 | 2029-12-31 | No data | 1890 STATE ROAD 436, SUITE 300, WINTER PARK, FL, 32792 |
| G09083900203 | MINER NORTH | ACTIVE | 2009-03-24 | 2029-12-31 | No data | 1890 STATE ROAD 436, SUITE 300, WINTER PARK, FL, 32792 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-05 | 7901 4TH ST N, STE 300, ST PETERSBURG, FL 33702 | No data |
| LC STMNT OF RA/RO CHG | 2023-08-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2023-08-22 | REGISTERED AGENTS INC | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-15 | 5243 Little Debbie Parkway, Suite 101, Ooltewah, TN 37363 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-15 | 5243 Little Debbie Parkway, Suite 101, Ooltewah, TN 37363 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-05 |
| CORLCRACHG | 2023-08-22 |
| ANNUAL REPORT | 2023-03-07 |
| ANNUAL REPORT | 2022-03-12 |
| ANNUAL REPORT | 2021-03-15 |
| ANNUAL REPORT | 2020-02-06 |
| ANNUAL REPORT | 2019-02-08 |
| ANNUAL REPORT | 2018-03-01 |
| ANNUAL REPORT | 2017-02-06 |
| ANNUAL REPORT | 2016-02-02 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
