| Entity Name: | LISA DAVIS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 20 Aug 2008 (16 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 10 Oct 2018 (6 years ago) |
| Document Number: | L08000079933 |
| FEI/EIN Number | 263219678 |
| Address: | 121 EAST 13TH STREET, ST. CLOUD, FL, 34769 |
| Mail Address: | 121 EAST 13TH STREET, ST. CLOUD, FL, 34769 |
| ZIP code: | 34769 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619318318 | 2013-07-10 | 2013-07-10 | 1114 ENGMAN ST, CLEARWATER, FL, 337553219, US | 1114 ENGMAN ST, CLEARWATER, FL, 337553219, US | |||||||||||||||||||||||
|
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| Phone | +1 727-443-0368 |
Authorized person
| Name | LISA DAVIS |
| Role | OWNER |
| Phone | 7274430368 |
Taxonomy
| Taxonomy Code | 311ZA0620X - Adult Care Home Facility |
| License Number | 6905967 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 142585400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DAVIS LISA G | Agent | 121 EAST 13TH STREET, ST. CLOUD, FL, 34769 |
| Name | Role | Address |
|---|---|---|
| DAVIS LISA G | Managing Member | 121 EAST 13TH STREET, ST. CLOUD, FL, 34769 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000045898 | DAVIS REAL ESTATE GROUP | ACTIVE | 2015-05-07 | 2025-12-31 | No data | 121 EAST 13TH STREET, ST CLOUD, FL, 34769 |
| G08242900144 | DAVIS REAL ESTATE GROUP | EXPIRED | 2008-08-29 | 2013-12-31 | No data | 2725 13TH STREET, SAINT CLOUD, FL, 34769 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2018-10-10 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2018-10-10 | DAVIS, LISA G | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-18 | 121 EAST 13TH STREET, ST. CLOUD, FL 34769 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-07 | 121 EAST 13TH STREET, ST. CLOUD, FL 34769 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-07 | 121 EAST 13TH STREET, ST. CLOUD, FL 34769 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J17000565723 | TERMINATED | 1000000756757 | OSCEOLA | 2017-09-28 | 2027-10-16 | $ 710.83 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, ORLANDO SERVICE CENTER, 400 W ROBINSON ST STE N302, ORLANDO FL328011759 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-29 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-04-30 |
| ANNUAL REPORT | 2021-02-25 |
| ANNUAL REPORT | 2020-03-18 |
| ANNUAL REPORT | 2019-04-22 |
| REINSTATEMENT | 2018-10-10 |
| ANNUAL REPORT | 2017-04-13 |
| ANNUAL REPORT | 2016-04-20 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
