| Entity Name: | 803 OAK STREET OPERATIONS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 17 Nov 2011 (13 years ago) |
| Date of dissolution: | 23 Sep 2022 (2 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2022 (2 years ago) |
| Document Number: | L11000131250 |
| FEI/EIN Number | 371653900 |
| Mail Address: | 1040 CROWN POINTE PKWY, STE 600, ATLANTA, GA, 30338-4741, US |
| Address: | 803 OAK STREET, GREEN COVE SPRINGS, FL, 32043, US |
| ZIP code: | 32043 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356610091 | 2011-12-27 | 2023-11-27 | 803 OAK ST, GREEN COVE SPRINGS, FL, 320434317, US | 803 OAK ST, GREEN COVE SPRINGS, FL, 320434317, US | |||||||||||||||||||||||||
|
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| Phone | +1 904-284-5606 |
| Fax | 9042840392 |
Authorized person
| Name | KENNETH USSERY |
| Role | VP |
| Phone | 4075711550 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1181096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004387500 |
| State | FL |
| Name | Role |
|---|---|
| CORPORATION SERVICE COMPANY | Agent |
| Name | Role |
|---|---|
| EPSILON HEALTH CARE PROPERTIES, LLC | Member |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G12000012045 | GOVERNOR'S CREEK HEALTH AND REHABILITATION | EXPIRED | 2012-02-03 | 2017-12-31 | No data | 803 OAK STREET, GREEN COVE SPRINGS, FL, 32043 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2022-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2018-06-19 | 803 OAK STREET, GREEN COVE SPRINGS, FL 32043 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2017-04-18 | 803 OAK STREET, GREEN COVE SPRINGS, FL 32043 | No data |
| MERGER | 2012-02-01 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000119879 |
| Name | Date |
|---|---|
| Reg. Agent Resignation | 2023-08-08 |
| ANNUAL REPORT | 2021-04-20 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-21 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-18 |
| AMENDED ANNUAL REPORT | 2016-07-14 |
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-04-17 |
| ANNUAL REPORT | 2014-05-01 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
