| Entity Name: | FL GOLDEN ADULT CARE, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Oct 2012 (12 years ago) |
| Document Number: | L12000130836 |
| FEI/EIN Number | 46-1192780 |
| Address: | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 34761 |
| Mail Address: | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 34761, US |
| ZIP code: | 34761 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1144624099 | 2014-10-21 | 2014-10-21 | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 347619000, US | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 347619000, US | |||||||||||||||||||||||
|
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| Phone | +1 407-690-9755 |
Authorized person
| Name | NANCY BUISSERETH |
| Role | OWNER |
| Phone | 4076909755 |
Taxonomy
| Taxonomy Code | 311ZA0620X - Adult Care Home Facility |
| License Number | CNA33740 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 012188600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BUISSERETH NANCY | Agent | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 34761 |
| Name | Role | Address |
|---|---|---|
| BUISSERETH NANCY | Manager | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 34761 |
| Name | Role | Address |
|---|---|---|
| NJOGU KEVIN | Secretary | 1686 RACHELS RIDGE LOOP, OCOEE, FL, 34761 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2015-01-02 | 1686 RACHELS RIDGE LOOP, OCOEE, FL 34761 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-07-08 | BUISSERETH, NANCY | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-07-08 | 1686 RACHELS RIDGE LOOP, OCOEE, FL 34761 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-21 |
| ANNUAL REPORT | 2024-02-07 |
| ANNUAL REPORT | 2023-01-22 |
| ANNUAL REPORT | 2022-01-22 |
| ANNUAL REPORT | 2021-01-21 |
| ANNUAL REPORT | 2020-02-12 |
| ANNUAL REPORT | 2019-01-16 |
| ANNUAL REPORT | 2018-01-16 |
| AMENDED ANNUAL REPORT | 2017-09-06 |
| ANNUAL REPORT | 2017-01-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
