| Entity Name: | SELAH-FOREST LAKE MANOR, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
SELAH-FOREST LAKE MANOR, 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: | 08 Sep 2010 (15 years ago) |
| Date of dissolution: | 29 Apr 2015 (10 years ago) |
| Last Event: | VOLUNTARY DISSOLUTION |
| Event Date Filed: | 29 Apr 2015 (10 years ago) |
| Document Number: | L10000093988 |
| FEI/EIN Number |
273357187
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 115 Professional Drive, PONTE VEDRA BEACH, FL, 32082, US |
| Mail Address: | 115 Professional Drive, PONTE VEDRA BEACH, FL, 32082, US |
| ZIP code: | 32082 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1316281215 | 2012-11-15 | 2012-11-15 | 252 FOREST LAKE BLVD, DAYTONA BEACH, FL, 321198106, US | 252 FOREST LAKE BLVD, DAYTONA BEACH, FL, 321198106, US | |||||||||||||||||||||||||
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| Phone | +1 386-760-7174 |
| Fax | 3867607812 |
Authorized person
| Name | MR. ALAN DANIEL PARRISH |
| Role | MANAGER |
| Phone | 9045431818 |
Taxonomy
| Taxonomy Code | 310400000X - Assisted Living Facility |
| License Number | AL8869 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 003453400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Filippone William T | Agent | 115 Professional Drive, PONTE VEDRA BEACH, FL, 32082 |
| SELAH SENIORCARE II, LLC | Manager | - |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000089637 | FOREST LAKE MANOR | EXPIRED | 2012-09-12 | 2017-12-31 | - | 50 A1A N. SUITE 110, PONTE VEDRA BEACH, FL, 32082 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2015-04-29 | - | - |
| REGISTERED AGENT NAME CHANGED | 2015-02-04 | Filippone, William T | - |
| CHANGE OF PRINCIPAL ADDRESS | 2014-01-08 | 115 Professional Drive, Suite 101, PONTE VEDRA BEACH, FL 32082 | - |
| CHANGE OF MAILING ADDRESS | 2014-01-08 | 115 Professional Drive, Suite 101, PONTE VEDRA BEACH, FL 32082 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2014-01-08 | 115 Professional Drive, Suite 101, PONTE VEDRA BEACH, FL 32082 | - |
| REINSTATEMENT | 2012-04-06 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | - | - |
| Name | Date |
|---|---|
| VOLUNTARY DISSOLUTION | 2015-04-29 |
| ANNUAL REPORT | 2015-02-04 |
| ANNUAL REPORT | 2014-01-08 |
| ANNUAL REPORT | 2013-01-16 |
| REINSTATEMENT | 2012-04-06 |
| Florida Limited Liability | 2010-09-08 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
