| Entity Name: | MAGNOLIA ADULT, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
MAGNOLIA ADULT, 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: | 25 May 2012 (13 years ago) |
| Date of dissolution: | 28 Sep 2018 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (7 years ago) |
| Document Number: | L12000070808 |
| FEI/EIN Number |
454978372
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 777 West Duval Street, LAKE CITY, FL, 32055, US |
| Mail Address: | 777 West Duval Street, LAKE CITY, FL, 32055, US |
| ZIP code: | 32055 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1841611407 | 2013-12-30 | 2013-12-30 | 1211 SW BASCOM NORRIS DR STE 201, LAKE CITY, FL, 320254916, US | 1211 SW BASCOM NORRIS DR STE 201, LAKE CITY, FL, 320254916, US | |||||||||||||||||||||||
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| Fax | 3867558595 |
Authorized person
| Name | MR. IRA D LEE |
| Role | OWNER |
| Phone | 3867553300 |
Taxonomy
| Taxonomy Code | 363LA2200X - Adult Health Nurse Practitioner |
| License Number | ARNP3091702 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | Y02HU |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LEE IRA DJR. | Managing Member | 777 West Duval Street, LAKE CITY, FL, 32055 |
| KHODR BILAL | Managing Member | 777 West Duval Street, LAKE CITY, FL, 32055 |
| LEE IRA DJR. | Agent | 777 West Duval Street, LAKE CITY, FL, 32055 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000012772 | LAKE CITY VEIN INSTITUTE | EXPIRED | 2014-02-05 | 2019-12-31 | - | 1211 SW BASCOM NORRIS RD., SUITE 201, LAKE CITY, FL, 32025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | - | - |
| REGISTERED AGENT NAME CHANGED | 2017-05-01 | LEE, IRA D, JR. | - |
| REINSTATEMENT | 2017-05-01 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | - | - |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-23 | 777 West Duval Street, LAKE CITY, FL 32055 | - |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-23 | 777 West Duval Street, LAKE CITY, FL 32055 | - |
| CHANGE OF MAILING ADDRESS | 2015-04-23 | 777 West Duval Street, LAKE CITY, FL 32055 | - |
| REINSTATEMENT | 2014-01-29 | - | - |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | - | - |
| Name | Date |
|---|---|
| REINSTATEMENT | 2017-05-01 |
| ANNUAL REPORT | 2015-04-23 |
| REINSTATEMENT | 2014-01-29 |
| Florida Limited Liability | 2012-05-25 |
Date of last update: 03 Apr 2025
Sources: Florida Department of State
