| Entity Name: | GV-ORMOND, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 20 Oct 2008 (16 years ago) |
| Document Number: | L08000098543 |
| FEI/EIN Number | 45-3976798 |
| Address: | 13770 - 58TH STREET NORTH, SUITE 312, CLEARWATER, FL 33760 |
| Mail Address: | 13770 - 58TH STREET NORTH, SUITE 312, CLEARWATER, FL 33760 |
| ZIP code: | 33760 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1326381609 | 2013-04-04 | 2013-04-04 | 13770 58TH ST N, SUITE 312, CLEARWATER, FL, 337603759, US | 535 N NOVA RD, ORMOND BEACH, FL, 321744405, US | |||||||||||||||||||||||||||||
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| Phone | +1 727-726-3980 |
| Fax | 7277265345 |
| Phone | +1 386-673-5000 |
| Fax | 3866730168 |
Authorized person
| Name | MR. DENNIS FORTE |
| Role | MANAGER |
| Phone | 7277263980 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL7460 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000592000 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GRAND VILLA 401(K) RETIREMENT PLAN | 2011 | 263621044 | 2012-07-16 | GV ORMOND, LLC | 43 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 263621044 |
| Plan administrator’s name | GV ORMOND, LLC |
| Plan administrator’s address | 13770 58TH STREET NORTH, SUITE 312, CLEARWATER, FL, 33760 |
| Administrator’s telephone number | 7277263310 |
Signature of
| Role | Plan administrator |
| Date | 2012-07-16 |
| Name of individual signing | TIM BARNES |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2008-01-01 |
| Business code | 623000 |
| Sponsor’s telephone number | 7277263310 |
| Plan sponsor’s address | 13770 58TH STREET NORTH, SUITE 312, CLEARWATER, FL, 33770 |
Plan administrator’s name and address
| Administrator’s EIN | 263621044 |
| Plan administrator’s name | GV ORMOND, LLC |
| Plan administrator’s address | 13770 58TH STREET NORTH, SUITE 312, CLEARWATER, FL, 33770 |
| Administrator’s telephone number | 7277263310 |
Signature of
| Role | Plan administrator |
| Date | 2011-07-08 |
| Name of individual signing | TIM BARNES |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| BEHRENFELD, CRAIG E | Agent | 601 BAYSHORE BLVD. SUITE 700, TAMPA, FL 33606 |
| Name | Role |
|---|---|
| DFGV HOLDINGS, INC. | Manager |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G09023900162 | GRAND VILLA OF ORMOND BEACH | EXPIRED | 2009-01-23 | 2024-12-31 | No data | 13770 58TH STREET N., SUITE 312, CLEARWATER, FL, 33760 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-21 | 13770 - 58TH STREET NORTH, SUITE 312, CLEARWATER, FL 33760 | No data |
| CHANGE OF MAILING ADDRESS | 2012-03-21 | 13770 - 58TH STREET NORTH, SUITE 312, CLEARWATER, FL 33760 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-29 |
| ANNUAL REPORT | 2021-04-27 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-05 |
| ANNUAL REPORT | 2017-04-29 |
| ANNUAL REPORT | 2016-04-28 |
| ANNUAL REPORT | 2015-03-18 |
Date of last update: 26 Jan 2025
Sources: Florida Department of State
