| Entity Name: | 5065 WALLIS ROAD OPERATIONS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 18 Nov 2011 (13 years ago) |
| Last Event: | CORPORATE MERGER |
| Event Date Filed: | 01 Feb 2012 (13 years ago) |
| Document Number: | L11000131332 |
| FEI/EIN Number | 80-0769064 |
| Address: | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 |
| Mail Address: | 1040 CROWN POINTE PKWY STE 600, ATLANTA, GA 30338-4741 |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891064549 | 2011-12-27 | 2023-11-27 | 5065 WALLIS RD, WEST PALM BEACH, FL, 334151947, US | 5065 WALLIS RD, WEST PALM BEACH, FL, 334151947, US | |||||||||||||||||||||||||
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| Phone | +1 561-689-1799 |
| Fax | 5616404603 |
Authorized person
| Name | KENNETH USSERY |
| Role | VP |
| Phone | 4075711550 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1198096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004778700 |
| 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 |
|---|---|---|---|---|---|---|
| G12000012152 | RENAISSANCE HEALTH AND REHABILITATION | ACTIVE | 2012-02-03 | 2027-12-31 | No data | 1040 CROWN POINTE PARKWAY, SUITE 600, ATLANTA, GA, 30338 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-23 | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 | No data |
| CHANGE OF MAILING ADDRESS | 2018-06-19 | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL 32751 | No data |
| REGISTERED AGENT NAME CHANGED | 2012-03-20 | CORPORATION SERVICE COMPANY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2012-03-20 | 1201 HAYS STREET, TALLAHASSEE, FL 32301-2525 | No data |
| MERGER | 2012-02-01 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 900000119919 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-23 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-21 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-21 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-17 |
| AMENDED ANNUAL REPORT | 2016-07-14 |
| ANNUAL REPORT | 2016-04-22 |
| Contract Type | Award or IDV Flag | PIID | Start Date | Current End Date | Potential End Date | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DELIVERY ORDER | AWARD | 36C24824N0821 | 2024-07-10 | 2025-01-09 | 2025-01-09 | |||||||||||||||||||||||||
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| Obligated Amount | 160000.00 |
| Current Award Amount | 160000.00 |
| Potential Award Amount | 160000.00 |
Description
| Title | EO14042 - ESTIMATED COMMUNITY NURSING HOMES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | 5065 WALLIS ROAD OPERATIONS LLC |
| UEI | VCS2ZJXSYC45 |
| Recipient Address | UNITED STATES, 5065 WALLIS RD, WEST PALM BEACH, PALM BEACH, FLORIDA, 334151947 |
| Unique Award Key | CONT_IDV_36C24819D0065_3600 |
| Awarding Agency | Department of Veterans Affairs |
| Link | View Page |
Award Amounts
| Obligated Amount | 0.00 |
| Potential Award Amount | 1920000.00 |
Description
| Title | EO14042 - ESTIMATED COMMUNITY NURSING HOMES |
| NAICS Code | 623110: NURSING CARE FACILITIES (SKILLED NURSING FACILITIES) |
| Product and Service Codes | Q402: NURSING HOME, LONG-TERM & ADULT DAY CARE SERVICES |
Recipient Details
| Recipient | 5065 WALLIS ROAD OPERATIONS LLC |
| UEI | VCS2ZJXSYC45 |
| Recipient Address | UNITED STATES, 5065 WALLIS RD, WEST PALM BEACH, PALM BEACH, FLORIDA, 334151947 |
| Status | User ID | Name of Firm | Trade Name | UEI | Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Active | P2353198 | 5065 WALLIS ROAD OPERATIONS LLC | - | VCS2ZJXSYC45 | 5065 WALLIS RD, WEST PALM BEACH, FL, 33415-1947 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| HUBZone Certified | No |
| Women Owned Certified | No |
| Women Owned Pending | No |
| Economically Disadvantaged Women Owned Certified | No |
| Economically Disadvantaged Women Owned Pending | No |
| Veteran-Owned Small Business Certified | No |
| Veteran-Owned Small Business Joint Venture | No |
| Service-Disabled Veteran-Owned Small Business Certified | No |
| Service-Disabled Veteran-Owned Small Business Joint Venture | No |
Bonding Levels
| Description | Construction Bonding Level (per contract) |
| Level | (none given) |
| Description | Construction Bonding Level (aggregate) |
| Level | (none given) |
| Description | Service Bonding Level (per contract) |
| Level | (none given) |
| Description | Service Bonding Level (aggregate) |
| Level | (none given) |
NAICS Codes with Size Determinations by NAICS
| Primary | Yes |
| Code | 623110 |
| NAICS Code's Description | Nursing Care Facilities (Skilled Nursing Facilities) |
| Small | Yes |
Export Profile (Trade Mission Online)
| Exporter | Firm hasn't answered this question yet |
| Export Business Activities | (none given) |
| Exporting to | (none given) |
| Desired Export Business Relationships | (none given) |
| Description of Export Objective(s) | (none given) |
Date of last update: 22 Feb 2025
Sources: Florida Department of State
