| Entity Name: | 9355 SAN JOSE BOULEVARD OPERATIONS LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| 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: | L11000131341 |
| FEI/EIN Number | 800769084 |
| Address: | 850 CONCOURSE PKWY S STE 250, MAITLAND, FL, 32751, US |
| Mail Address: | 1040 CROWN POINTE PKWY, STE 600, ATLANTA, GA, 30338-4741, US |
| ZIP code: | 32751 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568731206 | 2011-12-27 | 2023-11-27 | 9355 SAN JOSE BLVD, JACKSONVILLE, FL, 322575503, US | 9355 SAN JOSE BLVD, JACKSONVILLE, FL, 322575503, US | |||||||||||||||||||||||||
|
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| Phone | +1 904-739-0877 |
| Fax | 9044489253 |
Authorized person
| Name | KENNETH USSERY |
| Role | VP |
| Phone | 4075711550 |
Taxonomy
| Taxonomy Code | 314000000X - Skilled Nursing Facility |
| License Number | SNF1047096 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006110200 |
| 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 |
|---|---|---|---|---|---|---|
| G12000012160 | SAN JOSE HEALTH AND REHABILITATION CENTER | 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 | 2024-04-24 | 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 | No data |
| MERGER | 2012-02-01 | No data | CORPORATION WAS A MERGER RESULT. TOTAL NUMBER OF QUALIFIED CORPORATION(S) INVOLVED WAS 1. MERGER NUMBER 300000119903 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-24 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-04-22 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-04-20 |
| ANNUAL REPORT | 2019-04-21 |
| ANNUAL REPORT | 2018-04-23 |
| ANNUAL REPORT | 2017-04-18 |
| ANNUAL REPORT | 2016-04-22 |
| ANNUAL REPORT | 2015-04-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
