| Entity Name: | BREVARD HMA NURSING HOME, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 26 Jul 2010 (15 years ago) |
| Date of dissolution: | 23 May 2023 (2 years ago) |
| Last Event: | LC VOLUNTARY DISSOLUTION |
| Event Date Filed: | 23 May 2023 (2 years ago) |
| Document Number: | L10000078582 |
| FEI/EIN Number | 273142238 |
| Address: | 4000 Meridian Boulevard, Franklin, TN, 37067, US |
| Mail Address: | 4000 Meridian Boulevard, Franklin, TN, 37067, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750348215 | 2006-04-28 | 2014-01-30 | 8050 SPYGLASS HILL RD, VIERA, FL, 329407983, US | 8050 SPYGLASS HILL RD, VIERA, FL, 329407983, US | |||||||||||||||||||||||
|
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| Phone | +1 321-752-1000 |
Authorized person
| Name | LAURIE HOLTSFORD |
| Role | AUTHORIZED OFFICIAL |
| Phone | 6154657466 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF16320961 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 025347200 |
| State | FL |
| CIK number | Mailing Address | Business Address | Phone | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1554266 | 8050 SPYGLASS HILL ROAD, VIERA, FL, 32940 | 8050 SPYGLASS HILL ROAD, VIERA, FL, 32940 | 239-598-3131 | |||||||||||||||||||||||||
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| Form type | EFFECT |
| File number | 333-183203-55 |
| Filing date | 2012-08-30 |
| File | View File |
Filings since 2012-08-30
| Form type | 424B3 |
| File number | 333-183203-55 |
| Filing date | 2012-08-30 |
| File | View File |
Filings since 2012-08-10
| Form type | S-4 |
| File number | 333-183203-55 |
| Filing date | 2012-08-10 |
| File | View File |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role | Address |
|---|---|---|
| Hammons Kevin J | Manager | 4000 Meridian Boulevard, Franklin, TN, 37067 |
| Pitt Justin D | Manager | 4000 Meridian Boulevard, Franklin, TN, 37067 |
| Cash W. B | Manager | 4000 Meridian Boulevard, Franklin, TN, 37067 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000089668 | THE WUESTHOFF PROGRESSIVE CARE CENTER | EXPIRED | 2010-09-30 | 2015-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| G10000089828 | WUESTHOFF PROGRESSIVE CARE CENTER | EXPIRED | 2010-09-30 | 2015-12-31 | No data | 5811 PELICAN BAY BLVD., SUITE 500, ATTN: LEGAL DEPARTMENT, NAPLES, FL, 34108 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| LC VOLUNTARY DISSOLUTION | 2023-05-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2019-04-25 | 4000 Meridian Boulevard, Franklin, TN 37067 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2019-04-25 | 4000 Meridian Boulevard, Franklin, TN 37067 | No data |
| LC STMNT OF RA/RO CHG | 2014-02-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-02-25 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-02-25 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| Name | Date |
|---|---|
| LC Voluntary Dissolution | 2023-05-23 |
| ANNUAL REPORT | 2023-04-12 |
| ANNUAL REPORT | 2022-04-23 |
| ANNUAL REPORT | 2021-04-22 |
| ANNUAL REPORT | 2020-04-14 |
| ANNUAL REPORT | 2019-04-25 |
| ANNUAL REPORT | 2018-04-21 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-29 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
