| Entity Name: | LADY LAKE SNF LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 15 Apr 2010 (15 years ago) |
| Date of dissolution: | 29 Jun 2020 (5 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 29 Jun 2020 (5 years ago) |
| Document Number: | L10000040676 |
| FEI/EIN Number | 27-2394689 |
| Address: | 400 Rella Blvd, #200, Montebello, NY, 10901, US |
| Mail Address: | 400 Rella Blvd, #200, Montebello, NY, 10901, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1205189867 | 2012-10-19 | 2014-05-02 | 1835 NE MIAMI GARDENS DR, #368, NORTH MIAMI BEACH, FL, 331795035, US | 900 HIGHWAY 466, LADY LAKE, FL, 32159, US | |||||||||||||||||||
|
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| Phone | +1 352-396-6956 |
Authorized person
| Name | MR. TZVI BOGOMILSKY |
| Role | AUTHORIZED MEMBER |
| Phone | 3054017901 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008104600 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| BOGOMILSKY TZVI | Auth | 400 Rella Blvd, Montebello, NY, 10901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000028407 | THE VILLAGES REHABILITATION AND NURSING CENTER | EXPIRED | 2012-03-22 | 2017-12-31 | No data | 1835 NE MIAMI GARDENS DRIVE #368, NORTH MIAMI BEACH, FL, 33179 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-29 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-11 | 400 Rella Blvd, #200, Montebello, NY 10901 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-11 | 400 Rella Blvd, #200, Montebello, NY 10901 | No data |
| LC AMENDMENT | 2012-12-17 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2012-12-17 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-12-17 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2020-06-29 |
| ANNUAL REPORT | 2019-04-10 |
| ANNUAL REPORT | 2018-04-11 |
| ANNUAL REPORT | 2017-04-28 |
| ANNUAL REPORT | 2016-03-22 |
| ANNUAL REPORT | 2015-01-13 |
| ANNUAL REPORT | 2014-04-28 |
| ANNUAL REPORT | 2013-04-15 |
| LC Amendment | 2012-12-17 |
| ANNUAL REPORT | 2012-04-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
