| Entity Name: | SHADY LANE RETIREMENT HOME, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
SHADY LANE RETIREMENT HOME, LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 13 Jan 2009 (16 years ago) |
| Date of dissolution: | 27 Sep 2024 (7 months ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 27 Sep 2024 (7 months ago) |
| Document Number: | L09000003827 |
| FEI/EIN Number |
300589766
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 13814 amelia Pond Drive, Windermere, FL, 34786, US |
| Mail Address: | 13814 amelia Pond Drive, Windermere, FL, 34786, US |
| ZIP code: | 34786 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1114253754 | 2009-11-01 | 2009-11-01 | 201 ROSEFIELD AVE, LEESBURG, FL, 347485014, US | 201 ROSEFIELD AVE, LEESBURG, FL, 347485014, US | |||||||||||||||||||||||||
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| Phone | +1 352-728-1559 |
| Fax | 3527281703 |
Authorized person
| Name | MR. SEGUNDO LIZARDO |
| Role | OWNER/ADMINISTRATOR |
| Phone | 3527281559 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL6001 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 2209282005070 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PATEL TEJESH | Authorized Member | 201 ROSEFIELD AVENUE, LEESBURG, FL, 34748 |
| PATEL TEJESH | Agent | 201 ROSEFIELD AVENUE, LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2024-09-27 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2023-07-24 | 13814 amelia Pond Drive, Windermere, FL 34786 | - |
| CHANGE OF MAILING ADDRESS | 2023-07-24 | 13814 amelia Pond Drive, Windermere, FL 34786 | - |
| REGISTERED AGENT NAME CHANGED | 2019-01-22 | PATEL, TEJESH | - |
| REGISTERED AGENT ADDRESS CHANGED | 2018-06-29 | 201 ROSEFIELD AVENUE, LEESBURG, FL 34748 | - |
| LC AMENDMENT | 2018-06-29 | - | - |
| REINSTATEMENT | 2010-10-09 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | - | - |
| LC AMENDMENT AND NAME CHANGE | 2009-05-13 | SHADY LANE RETIREMENT HOME, LLC | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2023-04-07 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-01-22 |
| LC Amendment | 2018-06-29 |
| ANNUAL REPORT | 2018-03-08 |
| ANNUAL REPORT | 2017-04-10 |
| ANNUAL REPORT | 2016-02-03 |
| ANNUAL REPORT | 2015-02-27 |
| FAIN | Awarding Agency | Assistance Listings | Start Date | End Date | Description | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 3761895009 | Small Business Administration | 59.012 - 7(A) LOAN GUARANTEES | - | - | TO AID SMALL BUSINESSES WHICH ARE UNABLE TO OBTAIN FINANCING IN THE PRIVATE CREDIT MARKETPLACE | |||||||||||||||||||
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| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4738008409 | 2021-02-06 | 0491 | PPS | 201 Rosefield Ave, Leesburg, FL, 34748-5014 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 02 Apr 2025
Sources: Florida Department of State
